Meniere's disease

If you have ear pressure or pain, severe dizziness, hearing loss, and a ringing or roaring noise—also known as tinnitus—it could be a condition known as Meniere's disease.

What is Meniere's disease?

Named for the French doctor who discovered the disease, Ménière's primarily affects the body's hearing and balance organs, which are closely connected within the inner ear. Excess fluid and pressure in the inner ear leads to these symptoms.

Who gets Meniere's?

Although Meniere's disease can affect people of any age, people in their 40s and 50s are much more likely to experience it. This condition is considered to be chronic and there is no cure, but there are various treatment strategies that will minimize the effect on your life and relieve symptoms. It affects roughly 1 out of every 1,500 people, making it relatively rare. It can affect one or both ears.

What causes Meniere's disease?

People with Meniere's disease most likely have a problem with too much pressure or fluid in their inner, however, doctors still don't know exactly what causes it. It does appear more common among people with head injuries, allergies, respiratory infections, and sleep apnea.

Does it run in families?

About 7-10% of those affected have a family history of the condition, according to the UK nonprofit Meniere's Society.

Potential Meniere's triggers

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

• Alcohol use
• Stress and travel
• Side effects of certain medications
• Smoking
• Stress or anxiety
• Fatigue
• Hormonal fluctuations
• Weather changes, like changes in barometric pressure
• Family history of the disease
• Migraines

Symptoms of Meniere's disease

The four key symptoms:

• a feeling of pressure in the ear, known as "aural fullness"
• sudden dizzy spells
• tinnitus (ringing in the ears)
• muffled hearing or hearing loss, especially asymmetrical hearing loss

During an attack, a person's pupils may move rapidly side to side, known as nystagmus (see an example here). 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?

Symptoms vary from person to person. People with Meniere's will generally experience episodes in clusters with long periods of remission. Some sufferers will experience many attacks over a period of several days, and others will have an isolated attack every once in awhile. 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 four hours.

How do I make it go away?

When you experience an episode of Meniere's disease, it is best to 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.

Long-term, people with this condition generally have it for life.

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.

"It is important to acknowledge that 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 for Meniere's disease

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.
• Electronystagmography and electrocochleography (ECOG) tests to measure dizziness and balance
• Magnetic resonance imaging (MRI) which provides an image of your inner ear

Similar health conditions

To confirm a diagnosis of Meniere's disease, doctors need to rule out other diseases that cause similar symptoms, note the guideline authors. These include autoimmune inner ear disease (a common cause of sudden hearing loss), otosclerosis, acoustic neuromas, temporal bone fracture, otosyphilis, vestibular neuritis, vestibular migraines and acute labyrinthitis. These diseases generally respond to different treatment.

The four classic symptoms of Meniere's include pressure in the ear, hearing loss, vertigo and tinnitus.

If your only primary symptom is vertigo, it may not be Meniere's but instead a common condition known as BPPV.

Also, if you're having trouble sleeping or experiencing an increase in daytime sleepiness, you may want to get evaluated for obstructive sleep apnea. About 15% of people with Meniere's also have sleep apnea.

Stages of Meniere's disease and diagnosis

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

• Early stage: During this time, a person will experience sudden and often out-of-the-blue episodes of vertigo that last anywhere from 20 minutes to an entire day. An person's ear may feel blocked or full, and they may have some hearing loss, which typically goes away after the episode fades. It is also common to feel the effects of tinnitus.
• Middle stage: Symptoms of vertigo tend to become less severe during this stage, while 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: During the late stages of Meniere's disease, patients will not suffer from vertigo as often, and some people will be relieved from it forever. However, tinnitus and hearing loss will likely get progressively worse, and people will likely experience unsteady balance regularly. Most people at this stage feel unstable in dark lighting conditions, for example. The good news? Meniere's has no effect on life expectancy and is generally benign.

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. This is called a drop attack. 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.

Tinnitus and Meniere's disease

Many people who have frequent or constant ringing in the ears understandably hope there is treatment to make it go away. While there is typically no cure, tinnitus can be managed successfully, especially if you are careful about disease triggers and reduce your noise exposure.

Hearing loss with Meniere's disease

Meniere's disease can cause hearing loss, including mid- and 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). A person also might be more sensitive to higher-pitched sounds and find them uncomfortable, known as hyperacusis.

However, Meniere's disease is unpredictable and 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.

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.

How Meniere's affects mood and emotions

Along with the common symptoms of Meniere's disease, it's possible to suffer from depression or anxiety. About half of all Meniere's patients have depression, according to a 2020 systematic review that looked at the two conditions.

This isn't surprising: Since the ailment affects hearing, you may develop fear and lose confidence to have conversations with others or at work, which can contribute to depression or anxiety. In addition, dizziness symptoms tend to pop up out of nowhere, so those living with Meniere's can be in a constant anxious state, unsure of when an episode will occur.

The good news: There are ways to face the fear of living with Meniere's and tinnitus.

Meniere's vs BPPV

Is Meniere's disease related to benign paroxysmal positional vertigo (BPPV?) No, although both disorders are associated with vertigo, they are not usually related. However, it is possible to have both disorders at the same time.

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 looking at this issue 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. Plus, smoking increases your risk of hearing loss.
• Practice stress management: Stress and anxiety are both linked to Meniere's disease, but both can be a cause and symptom of the disease. Learning how to manage and identify stressors can bring relief. It also may be beneficial to try relaxation or meditation techniques.

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, benzodiazapenes 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, though this is often a last-resort solution.

There are plenty of other suggested Meniere's treatment options, but evidence is lacking for their use. This doesn't necessarily mean they won't work, they just haven't been studied. According to the National Institutes of Health, these treatments include cognitive-behavioral therapy, pressure pulse treatment, acupuncture and other alternative therapies.

Note: For an in-depth medical overview of Meniere's we recommend this page maintained by doctors with the Chicago Dizziness and Hearing clinic. 

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.