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If you have suffered from hearing loss and dizziness/giddiness, then you would probably have heard of Meniere's Disease (MD). It is somewhat akin to GLAUCOMA which affects the eye and vision, but unlike GLAUCOMA, MD affects the inner ear fluid pressure (in both the Cochlea and the Vestibular system).
Meniere’s disease (MD)
Ménière disease is a disorder caused by fluid build up in the inner ear chambers.
It causes symptoms such as vertigo, nausea, vomiting, loss of hearing, ringing in the ears, headache, loss of balance, and sweating.
Treatment choices may depend on the severity of the disease and you should discuss with your doctor about which choices are right for you.
Q: What is Ménière's disease?
Ménière disease is a balance disorder.
It is caused by an abnormality in a part of the inner ear called the labyrinth. Fluid build-up here can cause a severe spinning sensation (vertigo) and affect the hearing, which may fluctuate from time to time.
Q: What causes Ménière's disease?
The labyrinth holds the organs of balance and hearing. It’s made up of 2 parts:
Bony labyrinth
Membranous labyrinth
The membranous labyrinth is encased in bone and contains a fluid called endolymph.
When the head moves, the endolymph also moves. This causes nerve receptors in the membranous labyrinth to signal the brain about the body's motion.
Excess endolymph buildup in the labyrinth can interfere with the normal balance and hearing signals between the inner ear and the brain. This is what happens in Ménière disease.
Image of the inner ear anatomy
Fluid build-up in the inner ear may be caused by:
Allergies
Abnormal immune system response
Abnormal fluid drainage caused by a blockage
Post Head injury
Genetic risk
Migraine headaches
Viral infection
Most often, Ménière disease is caused by more than one factor.
Q: What are the risk factors for Ménière's disease?
Anyone can get Ménière disease.
It is more prevalent in people in their 40s and 50s. There is presently no cure for MD; treatment options are aimed at controlling the symptoms e.g. hearing loss and giddiness.
There is a correlation with migraine and MD is more common in ladies.
Q: What are the symptoms of Ménière disease?
These are the most common symptoms of Ménière disease.
Symptoms can happen suddenly and may occur daily or infrequently. The symptoms are most often in one ear but can affect both ears in about 20 per cent of cases.
Vertigo is the most debilitating symptom; this is a severe spinning sensation that is often associated with:
Severe nausea
Vomiting
Sweating
Image of a person suffering from dizziness and giddiness
Other symptoms may include:
Tinnitus (ringing in the ears)
Loss of hearing or muffled hearing
Loss of the ability to hear low frequencies
Pressure in the affected ear
Loss of balance
Headaches
The symptoms of Ménière disease may mimic other conditions or health problems. So it is important to get the correct diagnosis.
Q: How is Ménière disease diagnosed?
Your doctor will take a comprehensive medical history and perform a full physical exam,
The doctor may also request:
Hearing test. This will help find any changes in hearing related to disease in the middle ear or other causes.
Balance test eg VNG / vHIT / oVEMP / cVEMP
Magnetic resonance imaging (MRI) scans. An MRI is done to exclude any tumour e.g. Acoustic Neuroma
Electrocochleography (ECOG). This test measures the electrical activity of the inner ear.
Image of a patient doing a hearing test
You may see other specialists including:
Audiologist (for hearing evaluation)
Neurologist (for any concomitant conditions e.g. Migraine)
Q: How is Ménière disease treated?
Your doctor will discuss the various options and plan the best treatment based on:
Your age
Your overall health and medical history
How symptomatic you are
How well do you tolerate specific medicines, procedures, or therapies
How frequent and long the episodes are
Your opinion or preferences
Treatment options may include:
Medication. Medicines may be given to control allergies, reduce fluid build-up, reduce dizziness, or improve the blood circulation in the inner ear.
Change in diet. Eliminating caffeine, chocolate, alcohol, and salt may reduce the frequency and intensity of symptoms in MD patients.
Behavioural therapies. Reducing stress may lessen the severity of the disease symptoms.
Hearing Aids: to manage hearing loss and improve communication for patients.
Surgery. Several types of surgery are somewhat effective for treating the balance problems of Ménière disease eg vestibular nerve section or if the hearing is poor, a labyrinthectomy.
As of today, there is no cure for MD.
Different treatment options for Meniere's disease exist with great variability between countries and centers.
None of these treatment options cures the disease.
As many treatments significantly impact the functioning of surrounding structures, one should start with non-invasive approaches with the fewest possible side effects and proceed to more invasive steps.
Sodium restriction diet: Low-level evidence suggests that restricting sodium intake may help to prevent Meniere attacks.
Thiazide diuretics: Form the mainstay of medical treatment in many centres. Evidence suggests they reduce the frequency and severity of symptomatic episodes but do not appear to prevent hearing loss.
Betahistine: Substantial disagreement exists in the medical community about the use of betahistine. A Cochrane review found low-level evidence to support the use of betahistine with substantial variability between studies.
Intratympanic steroid injections: May reduce the number of vertigo attacks in patients with Meniere disease while preserving auditory function.
Image of Dr Euan performing the IT Dexa Injection procedure
5. Intratympanic gentamycin injections: Gentamycin has strong ablative properties towards vestibular cells. Side effects are sensorineural hearing loss because of a certain amount of toxicity toward cochlear cells.
6. Vestibular nerve section or labyrinthectomy: Nerve section is a therapeutic option in patients who failed the conservative treatment options, and labyrinthectomy when surgical options failed. Labyrinthectomy leads to complete hearing loss on the affected side.
Q: What are the complications of Ménière disease?
Vertigo is one of the main symptoms of Ménière disease. This can be quite disabling, depending on your occupation and/or lifestyle.
It can cause falls, trouble driving, or interfere with other normal activities of daily living.
Permanent hearing loss may also happen. Hearing aids can help rehabilitate hearing loss, for profound hearing loss, there is also the option of the Cochlear Implant or Bionic Ear.
All these problems can cause depression and anxiety. It may be hard to work or interact with your family and friends as MD is an invisible disease and patients may appear very well in between MD episodes. As such, work colleagues and even family members may not understand what the patient is going through, leaving the patient feeling lonely and helpless.
Your doctor needs to explain and communicate with your spouse/partner and family members about your MD so that you can get the support and help you need.
If you or a loved one are experiencing vertigo or symptoms of Meniere's disease, don't hesitate to reach out. Early diagnosis and treatment can significantly improve your quality of life and prevent further complications. Contact us today at Euan's ENT Surgery & Clinic or call 66944282 to schedule an appointment and take the first step towards managing your symptoms and improving your well-being.
If you would like to delve deeper into the topic of Meniere's disease, here are some useful references for you!
Have a good weekend! Dr Euan :-)
REFERENCES:
Magnan J, Özgirgin ON, Trabalzini F, Lacour M, Escamez AL, Magnusson M, Güneri EA, Guyot JP, Nuti D, Mandalà M. European Position Statement on Diagnosis, and Treatment of Meniere's Disease. J Int Adv Otol. 2018 Aug;14(2):317-321. [PMC free article] [PubMed]
Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A., Classification Committee of the Barany Society. Japan Society for Equilibrium Research. European Academy of Otology and Neurotology (EAONO). Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res. 2015;25(1):1-7. [PubMed]
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Mori N, Miyashita T, Inamoto R, Matsubara A, Mori T, Akiyama K, Hoshikawa H. Ion transport its regulation in the endolymphatic sac: suggestions for clinical aspects of Meniere's disease. Eur Arch Otorhinolaryngol. 2017 Apr;274(4):1813-1820. [PMC free article] [PubMed]
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