What is Meniere's Disease ?

Meniere's disease, named for the French physician Prosper Meniere, is a disorder of the inner ear which is characterized by episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. The area of the ear that is affected is the labyrinth, which includes both the semicircular canals and the cochlea. Meniere's disease affects about 2 people out of 1000 or .02% of the population (about the same prevalence as multiple sclerosis -MS). It is most common in people over 40 years of age, affecting about the same number of males and females.

A typical attack of Meniere's disease is preceded by fullness in one ear, hearing fluctuation, or changes in tinnitus (ringing in the ear). A Meniere's episode generally involves severe vertigo (spinning), imbalance, nausea and vomiting. The average attack lasts two to four hours. Following a severe attack, most people find that they are exhausted and must sleep for several hours. There is a large amount of variability in the duration of symptoms. Some people experience brief "shocks" and others have constant unsteadiness

A particularly disabling symptom is a sudden fall, called a "drop attack" that may occur without warning. Patients suddenly feel that they are tilted or falling (although they may be straight. This is a very disabling symptom as it occurs without warning and can result in injury. Meniere's attacks may occur within a short period. However, years may pass between episodes. Between the acute attacks, most people note only mild imbalance and tinnitus.

Meniere's disease usually starts confined to one ear but it often extends to involve both ears over time so that after 30 years, 5-35% of patients with Meniere's experience it bilaterally. According to one study, as many as 75% of persons who will develop Meniere's bilateraly do so within 5 years.

In most cases, a progressive hearing loss occurs in the affected ear(s). A low-frequency sensor neural pattern is commonly found initially, but as time goes on, it usually changes into either a flat loss or a peaked pattern. The disease is not fatal, although the symptoms can be incapacitating.

An acute attack of Meniere's disease is generally believed to result from fluctuating pressure of the fluid called endolymph within the inner ear. The membranes of the labrinyth can become dilated like a balloon when pressure increases. This is called "hydrops". One way for this to happen is when the drainage system, called the endolymphatic duct or sac is blocked, such as with scar tissue..This drainage system may also have been narrow from birth. In some cases there may be too much fluid produced. Abnormally enlarged fluid pathways into the ear such as the vestibular aqueduct or cochlear aqueduct may also be associated with Meniere's like symptoms. However, for the most part the underlying cause of Meniere's disease is unknown.

Now there is no cure for Meniere's disease, but there are ways to manage the condition and help control symptoms. Diagnosis is based on a combination of the right set of symptoms (usually episodic dizziness and hearing disturbance), hearing tests, which document that hearing is reduced after an attack, and then gets better. The process of diagnosis usually includes hearing testing, an MRI scan of the head, or an Electrocochleography (ECOG) Hearing tests often begin with showing a fluctuating low-frequency hearing loss. Over years, this gradually progresses to a peaked pattern with both low and high-tone reduction, and finally a flat pattern, typically 50 db loss (110 db would be completely deaf). While some people have hearing that fluctuates like this without any further symptoms of dizziness or tinnitus, in most cases, this does not progress to Meniere's disease.

Anna explains her experience with Meniere's: "I noticed first that I was having difficulty hearing on the telephone in my right ear. I went to the doctor and had a hearing test, and it was discovered that my hearing loss was mostly in the sound ranges of the human voice. The doctor ordered an MRI, which was normal. I also had feelings of fullness or heaviness in my ear, but did not have tinnitus or dizziness. The doctor said it sounded like Meniere's disease, and ordered me to take a diuretic and go on a low sodium diet. Within a few months, I began to have vertigo. It was especially bad in the mornings or on turning over at night. It felt like the room was spinning and would last from a few minutes to an hour or more. After an attack, I would feel exhausted and usually had to lie down and rest."

During an acute attack, lay down on a firm surface. Lie as still as possible as possible, with your eyes open and fixed on a stationary object. Do not try to drink or sip water, especially if nauseated. Stay like this until the severe vertigo (spinning) passes, and then get up very slowly. After the attack subsides, you will probably feel very tired and need to sleep for several hours. If vomiting persists and you are unable to take fluids, contact your doctor. He can prescribe medication, or he may wish to see you. Antivert and Ativan are commonly used vestibular suppressant medications and Compazine or Phenergan are commonly used medications for nausea.

Between attacks, medication may be prescribed to help regulate the fluid pressure in your inner ear, thereby reducing the severity and frequency of the Meniere's episodes. Dyazide is the most common medication for this purpose. Vestibular suppressants such as Antivert (meclizine) or Klonazepam are used on an as-needed basis.

Many doctors will also prescribe a low-salt diet. Experience has show that STRICT adherence to this dietary regimen will result in significant improvement in most patients. People with certain balance disorders must control the amount of salt and sugar that is added to food. You must also become aware of the hidden salts and sugars that foods contain. Limiting or eliminating your use of caffeine and alcohol will also help to reduce symptoms of dizziness and ringing in the ears.

The purpose of treatment between attacks is to prevent or reduce the number of episodes, and to decrease the chances of further hearing loss. A permanent tinnitus (ringing in the ears) or a progressive hearing loss may be the consequence of long-term Meniere's disease. Hearing aids may be necessary. In extremely severe cases, surgery may be considered. This is a last resort for persons who have severe attacks which are disabling. Some physicians recommend a profusion of gentamicin or dexamethasone.

People with certain balance disorders must control the amount of salt and sugar that is added to food. You must also become aware of the hidden salts and sugars that foods contain. Limiting or eliminating your use of caffeine and alcohol will also help to reduce symptoms of dizziness and ringing in the ears.

Since the acute symptoms of Meniere's disease are episodic, it is important to explain to your family and friends what might happen when you have an attack. Then, if the symptoms occur when they are present, they will understand and not be overly frightened.

You may be able to protect yourself from injury if you feel that an attack is about to begin. Some attacks may occur during the night, so be sure you have a night light on and that the path to the bathroom is free of obstructions.