Meniere's disease

 

If you have sudden bouts of ear pressure, dizziness, hearing loss, and tinnitus, it could be Meniere's disease.

The disease is named after Prosper Ménière, the French doctor who studied the disease in the 1800s. It primarily affects the hearing and balance organs, which are connected within the inner ear.

What causes Meniere's?

The cause is largely unknown. People with Meniere's disease most likely have a problem with too much pressure or fluid in their inner ear. However, doctors still don't know exactly why this happens. 

How common is Meniere's disease?

According to the British Meniere's Society, the condition affects about 1 out of every 1,000 people. In about 10% of cases, there is a family history of the disease. It can affect people of any age, but it's most common in midlife. It usually only affects one ear. 

Key symptoms of Meniere's disease:

• A feeling of pressure in the ear, known as "aural fullness"
• Sudden dizzy spells
• Tinnitus (ringing in the ears)
• Muffled hearing or hearing loss, that may fluctuate and be different in each ear (asymmetrical hearing loss)

Other possible symptoms

During an attack, a person's pupils may move rapidly from side to side, known as nystagmus. People with Meniere's disease also may struggle with "brain fog," or disoriented thinking and fatigue. Rarely, people also experience diplacusis, known as "double hearing."

How often do Meniere's attacks occur?

People will generally experience episodes in clusters with long periods of remission. Some sufferers will experience many attacks over a period of several days. Others will have an isolated attack. In other words, it's highly individual.

How do I know if I'm about to have an attack?

A Meniere's attack usually begins with the feeling of pressure in the ear, followed by tinnitus, hearing loss and vertigo. These episodes will last anywhere from 20 minutes to several hours.

How do I make it go away?

If you can, lie down and focus on one non-moving object, as this helps your inner ear rest. A nap may help, too. Any rescue medications you've been prescribed also may help, such as anti-nausea medication and anti-anxiety medication.

Stages of Meniere's disease and diagnosis

Meniere's disease commonly affects people in various stages, with symptoms developing over time. 

• Early stage: A person may experience sudden and often out-of-the-blue episodes of vertigo that last anywhere from 20 minutes to an entire day. Your ear may feel blocked or full, and you may have some hearing loss, which typically goes away after the episode fades. There may be ringing in the ears.
• Middle stage: Symptoms of vertigo tend to become less severe. Hearing loss and tinnitus will increase in severity. Many people will also experience long-term remission (the disease goes away) that can last several months.
• Late stage: Patients will not suffer from vertigo as often, and some people will be relieved from it forever. However, tinnitus and hearing loss may get progressively worse, and people will likely experience unsteady balance regularly. Most people at this stage feel unstable in the dark, for example.

What is a drop attack?

In rare cases, people with late-stage Meniere's disease may feel off balance and suddenly fall down but remain conscious and aware of what is happening. It can be very scary to experience a drop attack, and your doctor should be notified if you are experiencing them. In and of themselves they are not harmful, but they can lead to serious injuries. The website Dizziness and Balance has an in-depth page on drop attacks.

Potential Meniere's triggers

Basically anything that increases pressure or fluid in the inner ear can trigger an attack. However, triggers are different for everyone. Some of these may trigger a Meniere's episode in one person and not another:

• Alcohol
• Travel
• Side effects of certain medications
• Smoking
• Stress or anxiety
• Fatigue
• Hormonal fluctuations
• Weather changes, like changes in barometric pressure
• Migraines

How is Meniere's disease diagnosed?

Repeated bouts of tinnitus, hearing loss and vertigo are strong indicators of Meniere's disease. Still, since all of these issues are common and can be associated with other diseases, Meniere's can sometimes be difficult to diagnose.

"A full and accurate diagnosis may take many months to attain," write the authors of clinical practice guidelines published in the April 2020 issue of the Journal of Otolaryngology–Head and Neck Surgery.

Tests your doctor may order

There is no single test to detect and diagnose Meniere's disease. Testing can help rule out other conditions, though.

Tests may include:

• A hearing test with an audiologist to detect and measure hearing loss. This is painless and non-invasive.
• Electronystagmography and electrocochleography (ECOG) tests to measure dizziness and balance. Electrodes are placed in and around the ear and eyes to measure electrical activity in the nerves.
• Magnetic resonance imaging (MRI) which provides an image of your inner ear, allowing a doctor to see potential abnormalities.

Similar health conditions

Many health conditions can cause dizziness and other symptoms similar to Meniere's. 

These include autoimmune inner ear disease (a common cause of sudden hearing loss), otosclerosis, acoustic neuromas, acute labyrinthitis, temporal bone fracture, otosyphilis, vestibular neuritis, and vestibular migraines. These diseases generally respond to different treatment.

If your only primary symptom is vertigo, it may be a common condition known as BPPV.

Medical treatments for Meniere's

Unfortunately, many of the treatments for Meniere's haven't been studied extensively. The Cochrane Collaboration, which evaluates medical research, found only two treatments had any clinical trial evidence to support their use. Those are:

• Inner ear injections of gentamycin, an antibiotic, to help with dizziness. This is known as "chemical ablation." Cochrane researchers said one study showed it work, but it increases the risk of hearing loss. It is often recommended for people experiencing drop attacks.
• Inner ear injections of steroids to combat inflammation. One study indicated this may be effective.

For either treatment, though, more study is needed to know how effective they are, researchers concluded.

Other treatments for Meniere's

Other treatment options that have been less studied specifically for Meniere's include:

• Medications that treat dizziness, such as antihistamines like Benadryl, benzodiazepines and anticholinergics. Your doctor may recommend several medicines in these categories to help you manage an active attack.
• Diuretics, which are drugs that treat fluid retention.
• Surgery to reduce pressure and fluid in the inner ear. This is often a last-resort solution.

Hearing loss with Meniere's disease

Meniere's disease can cause hearing loss in one or both ears. Often a person will struggle to hear low-frequency hearing loss, meaning low-pitched sounds may be harder to hear (men's voices compared to women's voices, or the bass in music, for example). It's also called "reverse-slope" hearing loss for the downward sloping pattern it makes on an audiogram.

However, Meniere's disease is unpredictable. The hearing loss may not affect low frequencies, but instead high frequencies. Often the hearing loss comes and goes, making it harder to diagnose. 

Some people will gradually develop more serious levels of hearing loss, which may be only in one ear or both ears. Hearing loss in one ear causes unique problems but can be treated.

The hearing loss can range from mild to profound.

A person also might be more sensitive to higher-pitched sounds and find them uncomfortable, known as hyperacusis.

Treating hearing loss from Meniere's

Hearing aids can generally help, since the type of hearing loss is sensorineural in origin. When hearing loss is severe, CROS hearing aids or cochlear implants may be recommended.

Remedies and relief strategies for Meniere's

A variety of at-home remedies may help control Meniere's, although none of them have been studied extensively to know if they're effective or not.  

Meniere's diet recommendations

Dietary changes may decrease the amount of fluid in the inner ear, which can weaken the symptoms of the disease. Researchers concluded there aren't any good clinical trials on diet and Meniere's disease. The good news? These changes are worth trying because they aren't harmful and may improve your overall health:

• Eat a steady salt intake: Fluctuations in salt intake can make the pressure in your ear go up and down, possibly triggering an attack. Try to maintain a diet that isn't either very high or very low in sodium. Some people find a low-salt diet helpful, but this can be hard to maintain.
• Drink less caffeine: Caffeinated beverages can make symptoms like tinnitus worse, so it is best to decrease the amount of this stimulant in your diet.
• Drink less alcohol: Alcohol affects your body's balance system, making you feel dizzy.
• Watch for food triggers: You may find that eliminating some foods, especially those with gluten, may reduce the risk of a Meniere's attack, according to a 2021 review of diet and Meniere's.

More: How I manage Meniere's with a low-salt diet

Other lifestyle changes that can help with Meniere's

• Get an annual physical and blood work. Conditions like hypothyroidism and sleep apnea are more common among people with Meniere's, although no one knows exactly why. Catching and treating these conditions will improve your overall health, making Meniere's symptoms less burdensome.
• Stop smoking: Many people who suffer from Meniere's disease and who regularly smoke report weakened symptoms after quitting.
• Practice stress management: Depression and anxiety are all common among people who have Meniere's disease. Learning how to manage and identify stressors can bring relief. It also may be beneficial to try relaxation or meditation techniques.

Who treats Meniere's?

Generally ear, nose and throat doctors, known as ENTs, or otolaryngologists, treat inner ear disorders. Neurologists and audiologists also may be on your healthcare team. If you experience symptoms of tinnitus, hearing loss and dizziness, see your primary care doctor for a referral to an ENT physician or visit a hearing center near you. Always seek help right away if you experience sudden hearing loss.