Meniere's disease

Meniere’s disease affects the inner ear, which is the seat of hearing and balance. During an attack, the person experiences vertigo – a sensation that they or the world around them is moving. They feel dizzy and sick, their hearing is dominated by a hissing or roaring sound, and one or both ears feel full to bursting point.

Meniere’s disease may develop slowly over time, with a gradual loss of hearing, or suddenly with a vertigo attack. Attacks can be minutes or hours long. Afterwards, the person might experience mild deafness and feel unsure of their footing. As the disease progresses, the episodes of vertigo become less frequent and the deafness more severe.

Balance and hearing are affected

It is thought that Meniere’s disease is caused by a build-up of fluid inside the inner ear. This interrupts messages to the brain from both the balance and the hearing nerves, causing loss of control of these functions.

• Balance – the inner ear contains a series of canals filled with fluid. These canals are at different angles. When the head is moved, the rolling of the fluid inside these canals tells the brain exactly how far, how fast and in what direction the head is moving. Information from these canals is passed along to the brain via the vestibular (balance) nerve. If the brain knows the position of the head, it can work out the position of the rest of the body.
• Hearing – the cochlea is the snail-shaped hearing organ in the inner ear, which is also filled with fluid. This fluid moves in response to sounds. Messages are passed along the hearing nerve to the brain to tell us what we are hearing. The build-up of fluid associated with Meniere’s disease disturbs the hearing nerve endings, causing hearing fluctuation and eventually permanent damage.

A range of symptoms

The symptoms of Meniere’s disease include:

• Loss of clear hearing – or loss of ability to distinguish speech or location of sound.
• Loss of balance (vertigo) – the surroundings seem to spin. Some people feel a degree of motion sickness, while others might even vomit or experience diarrhoea.
• Noises in the ear (tinnitus) – described as hissing, roaring or ringing, or a combination of sounds. The tinnitus may be unrelenting or fades in and out. The volume of the tinnitus is variable too and often increases prior to a Meniere’s attack.
• Hearing loss – usually in the low frequencies and includes a fuzzy, unclear quality to sounds.
• Ear fullness – a sensation that the ear is under pressure and close to bursting.
• Sensitivity to noise – some noises can hurt the ears, while other noises might be quiet but of a particular pitch that causes pain.

Often one or two symptoms will be more noticeable than others, but a diagnosis of Meniere’s disease includes vertigo, hearing loss, tinnitus and a feeling of pressure.

Diagnosis

Many of the symptoms of Meniere’s disease can also be caused by other conditions, so diagnosis of the condition often involves first ruling out other medical possibilities.

There is no specific test for Meniere’s disease, but doctors use a range of tests in combination to help diagnose the disorder. These include:

• Hearing tests – to test if hearing loss is specific to your inner ear.
• Low frequency loss – this is an indicator of Meniere’s.
• Electronystagmography (ENG) – measures involuntary eye movement while balance is put under stress.
• Magnetic resonance imaging (MRI) – may be used to rule out disorders of the central nervous system that may be confused with Meniere’s disease, such as acoustic neuroma, Arnold-Chiari malformation and multiple sclerosis.

Non-surgical treatment

There is no cure for Meniere’s disease. Treatment generally focuses on managing symptoms and preventing or decreasing the number of attacks. Where possible, the aim is to conserve hearing and reduce balance problems.

Non-surgical options include:

• Medication – to control vertigo, nausea and vomiting, and reduce anxiety and fluid retention.
• Lifestyle changes – stress management, dietary changes, quitting smoking.
• Pressure pulse devices – to help relieve the build-up of pressure and reduce vertigo for people whose symptoms do not respond to medical therapy.
• Chemical ablation – an antibiotic is used to reduce or destroy the remaining balance (vestibular) functions of the inner ear so signals are no longer sent to the brain.

Surgery is a last resort

If you are experiencing severe attacks of vertigo and medical treatments don’t help, surgery may be considered. This may include procedures that:

• Alter the build-up of fluid in your inner ear (endolymphatic sac procedures)
• Destroy the balance mechanism of the inner ear (vestibular nerve section or vestibular neurectomy) – these are serious operations that may carry a risk of hearing loss, can temporarily disrupt your balance and may require a period of rehabilitation.

Rehabilitation

If you experience balance problems between attacks, you may benefit from doing exercises and activities that help your body and brain regain the ability to process balance information correctly. This is called vestibular rehabilitation therapy.

Managing the condition

Your doctor can help you to find ways to manage your symptoms and help reduce the frequency and severity of attacks associated with Meniere’s disease. Some suggestions include:

• Recognise the warning signs of an attack – sit or lie down immediately when you feel dizzy.
• Rest – during and after attacks, before returning to regular activities.
• Avoid triggers – that make your symptoms worse, including sudden movement, bright lights, watching television or reading.
• Beware of losing your balance – good lighting, an even walking surface and use of a walking stick can help you to maintain stability and avoid a fall.
• Avoid driving a car or operating heavy machinery – if you experience frequent episodes of vertigo, as this could lead to an accident and injury.
• Use a hearing aid – if you experience hearing loss.
• Eat regular meals – an even intake of food and drink throughout the day can help regulate your body fluids.
• Reduce your salt (sodium) intake – eating too much salt may increase the fluid in your inner ear and make your symptoms worse. Aim to eat no more than 1,000mg of sodium per day. Most fresh foods are naturally low in salt, but processed foods often are not.
• Avoid caffeine and alcohol – excessive amounts of caffeine (in tea, coffee, chocolate and cola drinks) or alcohol can constrict your blood vessels and make your symptoms worse.
• Quit smoking – avoiding nicotine may lessen the severity of your symptoms.
• Join a support group – offers understanding and information to help you live with and manage your condition. Your doctor can recommend a support group in your area.

Where to get help

• Your doctor
• Hearing specialist – ear, nose and throat specialist (ENT)
• Audiologist
• Meniere's Australia Tel. 1300 368 818

Things to remember

• Meniere’s disease affects the inner ear, the seat of hearing and balance.
• The exact cause of the disease is unknown.
• Treatment options include medication, diet and lifestyle changes and, as a last resort, surgery.

You might also be interested in:

• Acoustic neuroma.
  
• Benign paroxysmal positional vertigo (BPPV).
  
• Deafness - a range of causes.
  
• Dizziness and vertigo.
  
• Ears explained.
  
• Hearing loss - how it affects people.
  
• Hearing tests explained.
  
• Salt.
  
• Tinnitus - insomnia and sleep problems.
  
• Tinnitus - reducing the impact.
  
• Tinnitus explained.
  

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Meniere's Support Group

Fact sheet currently being reviewed.
Last reviewed: February 2010

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Meniere's disease affects the ear, which is the seat of hearing and balance. The condition causes vertigo, dizziness, fluctuating hearing loss and tinnitus (ringing or hissing in the ears). Attacks can be minutes or hours long. Over time, the hearing is permanently damaged. There is no cure but the condition can be managed.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

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