Meniere's disease

The exact cause of Meniere's disease isn't known. It's thought to be caused by a build up of fluid in the inner ear. This is different to fluid in the middle ear after an ear infection (glue ear).

The inner ear includes the semicircular canals which sense head movements and control balance, and the cochlea which senses sound for hearing. These are filled with fluid. When too much fluid builds up it causes pressure which causes the symptoms of Meniere's disease. The cause of the fluid build up is unknown – it may be that your body produces too much fluid, or that the fluid doesn't drain as it should from the inner ear. Or it may be both. 

Image credit: Wikimedia Commons

Meniere's disease usually happens in people aged over 40 years. It's not common, about 1 in 1,000 people get it, and it's hard to predict who will get Meniere's disease. However, your risk may be higher than normal if you have: 

• a family/whānau member who has it
• an autoimmune disease
• had a viral infection of the inner ear.

Your healthcare provider will ask you to describe your symptoms and will do an examination. There are many other problems that can cause vertigo so you may need tests (eg, a hearing test, an MRI or other specialised tests). You may also be referred to an ear, nose and throat (ENT) specialist or audiologist (hearing specialist). 

Meniere's disease affects different people differently. When you're first diagnosed, it's not possible to predict how badly it will affect you in the coming years.

• You may find that months or years go by between attacks or attacks may be more frequent.
• Sometimes attacks come in clusters, one after the other, that last for a week or so.
• Some attacks are minor and don't last long. Other attacks can be very distressing with severe vomiting and dizziness.
• Vertigo attacks can come without dulled hearing, but you don't usually get dulled hearing without having vertigo.
• Attacks usually stop as suddenly as they start.

If you have sudden, severe attacks it may not be safe to drive as the risk of an accident is high. Discuss this with your healthcare provider.

For most people (7 out of 10), the attacks stop happening after 5–10 years. However, some permanent hearing loss or permanent noises in the ear (tinnitus) may have developed in the affected ear or ears by this time. 

Fortunately there are treatments that can ease symptoms.

There's no cure for Meniere's disease, but a combination of lifestyle changes and medication can help make attacks less severe – mainly helping with vertigo. There's no treatment for the hearing loss that happens with Meniere's disease. 

Lifestyle changes

Meniere's disease can be hard to manage and tough to live with. Here are a few lifestyle changes that may help:

• Limit salt in your diet to less than 2,300 milligrams per day, and don’t have large amounts all at once. Follow a ‘no added salt’ diet – this means not adding salt to your food while you are cooking or before you eat, and avoiding foods which taste salty (use other herbs and spices to make your food tasty.)  Food and drink high in salt can boost the amount of water in your inner ear.
• Limit caffeine and alcohol as they can trigger attacks for some people. Keeping a diary can help you work this out.
• If you smoke, quit. Smoking can increase attacks.
• Seek out a support group. Although there isn't an active support group dedicated to Meniere’s disease in Aotearoa New Zealand, there are online support groups in other countries.

During an attack

When you have an attack:

• Lie down and hold your head very still until the symptoms go away.
• Focus on a faraway object that isn't moving and notice the feeling of clothes and air against your skin – this helps your brain sort out the mixed balance messages it's getting.
• Don’t drive.
• Avoid watching TV, reading, bright lights or anything that makes your symptoms worse – keeping a diary may help you figure out what makes them worse. 
• After an episode don’t rush back into movement – your body needs rest, and to slowly adjust to normal balance again.

Between attacks

When you have an attack of vertigo, you're at risk of falls and injury. Between episodes you can take steps to help protect yourself, such as:

• Do exercises to improve your balance. This is called vestibular physiotherapy. Your GP or nurse practitioner can refer you. This can reduce your risk of falling and hurting yourself or others.
• Make changes to reduce your risk of injury during a vertigo attack, eg, install grab bars in your bathroom.
• Wear shoes with low heels and non-slip soles.

Medicines

Your healthcare provider may prescribe medicines to take during an attack:

• Medicines that control nausea and vomiting during an episode of vertigo (called anti-nausea medications) such as prochloperazine, promethazine or cyclizine.
• Medicines to reduce inflammation in the inner ear, such as prednisone. You may be started on a high dose which is reduced slowly over a few days.

Your healthcare provider may prescribe daily medicine to prevent further episodes, eg, betahistine or bendroflumethiazide. It's not clear whether these medicines work well so your healthcare provider may discuss this with an ENT specialist.

Other treatments 

 Hearing aids for hearing loss

• If you develop permanent hearing loss, you may benefit from a hearing aid.
• If loud sounds become distressing then an audiologist or hearing therapist can provide you with advice on compression hearing aids which may help to ease this symptom.  

Sound therapy for tinnitus

• If you develop permanent noises in the ear (tinnitus) then various strategies may be advised.
• For example, an audiologist or hearing therapist may advise on sound therapy.
• This often uses a CD or an MP3 player to play soothing and relaxing sounds, helping to distract you from the sound of tinnitus.
• Some people have found coping strategies, relaxation training, counselling, and other such techniques useful

Physiotherapy for loss of balance 

• A physiotherapist may be involved if your balance becomes permanently affected (in severe cases).

Intratympanic gentamicin

• An injection through the eardrum can disable the pressure detectors in the inner ear. This is done by an ENT specialist.

Surgery

• Rarely, surgery is used to stop very severe symptoms. But this can cause complete deafness and has risks because it is so close to the brain.

Apps reviewed by Healthify

You may find it useful to look at some Tinnitus apps and Vertigo apps.