Ever feel like you’re on a spinning carousel that seems to go on and on? And no, we’re not referring to the merry-go-round of life, though sometimes that can present with similar symptoms. If you experience attacks of severe dizziness and vertigo, sometimes accompanied with nausea and vomiting, you may be suffering from Meniere’s Disease.
There are an estimated 600,000-750,000 cases of Meniere’s disease in the US and about 45,000-60,000 new cases are diagnosed annually. The global prevalence sits at about 12 people for every 1000, making it a relatively rare condition; in the US specifically, this rate is about 0.2%.
Meniere’s Disease gets its fancy name from a French physician named Prosper Ménière, who first described the condition on or about 1861. It is a disorder of the inner ear in a section called the labyrinth. As the organs contained within the labyrinth are responsible (at least in part) for balance and hearing, in addition to sudden attacks of severe vertigo, other symptoms of a Meniere’s episode include imbalance, gait unsteadiness, tinnitus, and progressive hearing loss. Many patients report a feeling of fullness or aching either in one or both ears, or an alteration to their hearing prior to embarking on the spinning carousel of a Meniere’s attack. Meniere’s is typically unilateral, involving only one ear, though around 15% of sufferers are unfortunate enough have both ears affected. Episodes of vertigo last for at least 20 minutes, on average for 2 to 4 hours, and infrequently, up to 24 hours. The attacks can be exhausting, with sufferers needing to recover with sleep afterward. The time between episodes varies greatly, even up to a number of years.
What Causes Meniere’s Disease?
As with many conditions in medicine (and generally in life), we don’t yet fully understand what causes Meniere’s Disease. It is known that symptoms are caused by increases in volume and pressure of fluid in the labyrinth, called endolymph, but what causes this to occur in the first place is unknown. This build-up of endolymph interrupts normal signalling of balance and hearing between the inner ear to the brain, resulting in the typical symptoms of a Meniere’s episode.
Several proposed theories exist, such as resulting from viral infection or autoimmune disease. Anatomical abnormalities have also been suggested, leading to ineffective drainage of endolymph from the inner ear. It is unclear whether there are hereditary links to Meniere’s though it has been recognized to run in families. It is possible that no single underlying cause exists and Meniere’s results from a combination of factors.
How is Meniere’s Disease Diagnosed?
Diagnosis of Meniere’s involves meeting certain symptomology criteria and a clinical exam to rule out other conditions that may share the same symptoms. During an attack, patients with a diagnosis of Meniere’s must experience:
- At least two episodes of vertigo lasting for at least 20 minutes each
- Tinnitus (a phantom buzzing, rushing, ringing sound in the ear)
- Fluctuating hearing impairment, which may be exacerbated during an attack but is progressive over time with the disease
- A feeling of fullness or congestion in the ear
A hearing test with audiometry will assess the nature of the sensorineural hearing loss in Meniere’s. Typically, the loss will be greater at lower frequencies. An audiogram at the time of diagnosis can also be useful for monitoring progression of the disease.
Medical imaging with an MRI is often included in making a diagnosis of Meniere’s as other potential conditions with similar symptoms include vestibular migraines, brain tumors, multiple sclerosis, or a brainstem stroke (and you certainly don’t want to miss that one as it could take you off the carousel of life pretty quickly).
How is Meniere’s Disease Treated?
Unfortunately, there is no cure for Meniere’s. Available treatments that help to reduce the severity or frequency of attacks also appear to vary in effectiveness from individual to individual.
Medications that relieve or shorten the duration of dizziness and vertigo, such as motion sickness and anti-nausea drugs, may be the first line of treatment as vertigo is the most disabling symptom of an attack. In the long-term, some doctors may prescribe diuretic medication in an attempt to reduce fluid retention and prevent endolymph build-up from triggering an episode. Certain lifestyle modifications also follow this line of thinking – reducing salt in the diet to under 1.5g/day, and limiting caffeine, alcohol, and chocolate.
The hearing loss associated with Meniere’s can be addressed with a hearing aid but is not likely to help with preventing or reducing the impact of an attack.
More invasive treatments are available for those who are unresponsive to medication or whose lives are too much like a box of chocolates to be able to give them up. Injections of steroid medications into the middle ear (and subsequently absorbed into the inner ear) may help to control vertigo for some patients. Gentamicin, an antibiotic, is also administered via injection to the middle ear and may be more effective than steroidal injections but carries a greater risk of exacerbating hearing loss.
Surgery is saved as a last resort. Endolymphatic sac decompression alleviates endolymph accumulation and may include the insertion of a tube to aid drainage of fluid. A labyrinthectomy is drastic, as it involves removal of the labyrinth and subsequently, also both balance and hearing ability from the affected ear. Only patients with profound hearing loss in the affected ear are suitable for this procedure. Vestibular neurectomy is a procedure that involves severing the nerve between the balance organs of the inner ear to the brain and is effective in around 95% of patients in relieving vertigo. This is basically brain surgery and carries all the usual risks of such operations but is likely to preserve hearing in the affected ear.
Another aspect to the management of Meniere’s is the anxiety and stress individuals feel between attacks. Because an episode can occur unexpectedly, patients may benefit from counselling or cognitive therapy that equip them with strategies to cope with this psychological burden and continue with their daily activities. Vertigo from the rollercoaster of life is much preferred over that from Meniere’s Disease.
Epidemiology of Meniere’s Disease. https://www.dizziness-and-balance.com/disorders/menieres/men_epi.html
Meniere’s Disease statistics. https://hearinghealthfoundation.org/menieres-disease-statistics
Meniere’s Disease. https://www.american-hearing.org/disease/menieres-disease/#:~:targetText=Meniere’s%20affects%20roughly%20615%2C000%20people,45%2C500%20new%20cases%20are%20diagnosed.
Meniere’s Disease. https://brainfoundation.org.au/disorders/menieres-disease/
Fact sheet: what is Meniere’s Disease? https://www.deafnessforum.org.au/fact-sheet-what-is-menieres-disease/
Meniere Disease (Meniere’s disease; endolymphatic hydrops). https://www.msdmanuals.com/en-au/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/meniere-disease
Meniere’s Disease. https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910