Ménière's Disease

The Facts

Ménière's disease is a condition that affects the inner ear. It causes attacks of dizziness (vertigo), nausea and vomiting, a feeling of fullness in the ear, hissing and roaring in the ears, and some hearing loss.

The disease comes on without warning. It may come and go over a person's lifetime. It often leaves no lasting symptoms in between bouts, and people who have it can live perfectly normal lives.

The condition affects men and women, and usually begins between the ages of 20 and 50. Usually only one ear is affected, although 10% to 50% of people with Ménière's disease develop it in both ears.

The Causes

The cause of Ménière's disease is unknown. The symptoms are believed to be related to having too much fluid in the inner ear. Occasionally, this potassium-rich fluid breaks the inner ear membrane and leaks into the potassium-poor outer fluid. This mixing causes a chemical reaction that paralyses the balance system in the inner ear until the fluid balance becomes normal again.

Symptoms And Complications

Dizziness, nausea, vomiting, ear fullness, ringing in the ears, and some hearing loss are all symptoms of an attack of Ménière's disease. A person with this condition usually has one or more attacks a year, which may come alone or in groups. The attacks last from approximately 20 minutes up to 24 hours and go away gradually. During a dizzy spell, the person feels like the world is whirling around them. They stagger from side to side and sometimes even fall down. These falling spells are called drop attacks or Tumarkin spells.

If you have Ménière's disease, you may also experience tinnitus, which is a hissing, ringing, or roaring in the affected ear that may continue, change, or disappear. Tinnitus may worsen during, just before, or just after a dizzy spell. People with Ménière's disease also have trouble hearing voices and music properly. Their hearing often comes back between attacks, but they do lose some hearing permanently over time.

While having an attack of Ménière's disease, you may also get a headache, grow pale, sweat, develop a slow pulse, and feel nauseous and vomit.

A person with the condition can go for years without having another attack and sometimes they never experience another attack. Between attacks, the person feels fine. However, the hearing in the affected ear (or ears) often declines gradually over time. Since the dizziness is unpredictable, people with Ménière's disease may be constantly concerned about having a dizzy spell and therefore often avoid driving or operating machinery. If attacks have occurred without warning, your doctor is obliged to advise you against driving.

Making A Diagnosis

Your doctor will review your symptoms and medical history, and do a physical exam. Hearing tests and other tests of ear function will also take place, and a magnetic resonance imaging

(MRI) scan may be done to check if there is a brain tumour.

Treatment And Prevention

Currently, there is no way to cure Ménière's disease. Treatments include acupuncture, herbal remedies, and various medications. Diuretics, vasodilator medications, and a low-salt diet help relieve symptoms by taking fluid away from the head and ear and maintaining the fluid balance in the body. Avoiding caffeine, alcohol, and nicotine may also help.

Diuretics, also referred to as "water pills," such as hydrochlorothiazide-triamterene, are medications that force the kidneys to pass more fluid, salt, and potassium than normal from the body. Taking these between attacks may reduce the frequency of attacks. People taking some types of diuretics also have to take extra potassium to replace the potassium the diuretics remove. Anti-nausea medications such as dimenhydrinate* can be taken in the form of tablets or suppositories. Betahistine is another medication that can be used to treat the vertigo associated with Meniere’s disease. Anti-anxiety medications such as lorazepam may also relieve vertigo symptoms but won’t prevent attacks.

Listening to music can "mask" the tinnitus or noises in a person's ears. Some people wear a tinnitus masker, which is a little device that makes noise behind their ear to block the awareness of the tinnitus.

If these treatments don't work, surgery may be an option. However, it doesn't always work and can cause ear damage. A type of surgery called labyrinthectomy usually relieves the dizziness but it results in total hearing and balance loss in the affected ear.

Another surgical procedure involves cutting the nerve leading to the organ of balance in the middle ear. Like a labyrinthectomy, this procedure relieves the dizziness. However, unlike a labyrinthectomy, it often preserves the hearing in the ear that was operated on. It is a more complex operation and requires a longer hospital stay, and there is a risk of damage to other parts of the ear.

Endolymphatic sac surgery is another type of surgery that is often used for people who have dizziness but good hearing, as it can relieve the dizziness and usually preserves hearing in the ear that is operated on. However, in a small number of cases, hearing gets worse. It does not usually relieve tinnitus. A "shunt" or plastic tube to drain fluid from the ear isn't always successful.

Chemicals can also be used to destroy either all or part of the balancing functions of the ear. The medication gentamicin is placed into the middle ear using a tube through the eardrum. It destroys some hearing cells, but it helps make the vertigo attacks less severe and may leave people with enough hearing so that they can function. However, hearing loss is a possibility.