Ménière's disease (patient information)

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Overview
Meniere's disease is an inner ear disorder that affects balance and hearing. The disorder usually affects only one ear and is a common cause of hearing loss. The disease is named after the French physician Prosper Ménière who first described the syndrome in 1861. About 100,000 people a year develop Meniere's disease.

What are the symptoms of Ménière's disease?
Symptoms include:


 * Abnormal sensations of movement (vertigo)
 * Gets worse with sudden movement
 * Lasts for a few minutes to several hours, may come and go
 * Dizziness
 * Hearing loss in one or both ears
 * Low frequency noises lost first
 * Extent of hearing loss may change
 * Noises or ringing in the ear (tinnitus)
 * Sudden episodes of complete disorientation that causes the person to fall down
 * Sweating (may be heavy)
 * Uncontrollable eye movements
 * Vomiting and nausea
 * The feeling of dizziness and being off balance generally come in attacks that last from minutes to hours. Other symptoms can last for longer.

The symptoms of Ménière's disease occur suddenly and can arise daily or as infrequently as once a year. Vertigo, often the most debilitating symptom of Ménière's disease, typically involves a whirling dizziness that forces the sufferer to lie down. Vertigo attacks can lead to severe nausea, vomiting, and sweating and often come with little or no warning.

Some individuals with Ménière's disease have attacks that start with tinnitus (ear noises), a loss of hearing, or a full feeling or pressure in the affected ear. It is important to remember that all of these symptoms are unpredictable. Typically, the attack is characterized by a combination of vertigo, tinnitus, and hearing loss lasting several hours. People experience these discomforts at varying frequencies, durations, and intensities. Some may feel slight vertigo a few times a year. Others may be occasionally disturbed by intense, uncontrollable tinnitus while sleeping. Ménière's disease sufferers may also notice a hearing loss and feel unsteady all day long for prolonged periods. Other occasional symptoms of Ménière's disease include headaches, abdominal discomfort, and diarrhea. A person's hearing tends to recover between attacks but over time becomes worse.

What causes Ménière's disease?
The symptoms of Ménière's disease are associated with a change in fluid volume within the fluid-filled tubes of the inner ear. These tubes are called semicircular canals, or labyrinths, and, along with a nerve in your skull, help interpret your body's position and maintain your balance. The labyrinth has two parts: the bony labyrinth and the membranous labyrinth. The membranous labyrinth, which is encased by bone, is necessary for hearing and balance and is filled with a fluid called endolymph. When your head moves, endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion. An increase in endolymph, however, can cause the membranous labyrinth to balloon or dilate, a condition known as endolymphatic hydrops.

Meniere's disease occurs when a part of the canal, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals.

The exact cause of Meniere's disease is unknown. In some cases, it may be related to:

Head injury Middle ear infection Syphilis

Other risk factors include:


 * Allergies
 * Alcohol use
 * Fatigue
 * Recent viral illness
 * Respiratory infection
 * Smoking
 * Stress
 * Use of certain medications, including aspirin

Genetics may also play a role.

Many experts on Ménière's disease think that a rupture of the membranous labyrinth allows the endolymph to mix with perilymph, another inner ear fluid that occupies the space between the membranous labyrinth and the bony inner ear. This mixing, scientists believe, can cause the symptoms of Ménière's disease. Scientists are investigating several possible causes of the disease, including environmental factors, such as noise pollution and viral infections, as well as biological factors.

Who is at highest risk?
Risk factors include:
 * Allergies
 * Alcohol use
 * Fatigue
 * Recent viral illness
 * Respiratory infection
 * Smoking
 * Stress
 * Use of certain medications, including aspirin

When to seek urgent medical care?
Call for an appointment with your health care provider if symptoms of Meniere's disease, such as hearing loss, ringing in the ears, or dizziness, occur or worsen.

Diagnosis
Based on a recent study, NIDCD estimates that there are currently approximately 615,000 individuals with diagnosed Ménière's disease in the United States and 45,500 newly diagnosed cases each year. Proper diagnosis of Ménière's disease entails several procedures, including a medical history interview and a physical examination by a physician, hearing and balance tests, and medical imaging with magnetic resonance imaging (MRI). Accurate measurement and characterization of hearing loss are of critical importance in the diagnosis of Ménière's disease.

Through the use of several types of hearing tests, physicians can characterize hearing loss as being sensory, arising from the inner ear, or neural, arising from the hearing nerve. Recording the auditory brain stem response, which measures electrical activity in the hearing nerve and brain stem, is useful in differentiating between these two types of hearing loss. Electrocochleography, recording the electrical activity of the inner ear in response to sound, helps confirm the diagnosis.

To test the vestibular or balance system, physicians irrigate the ears with warm and cool water or air. This procedure, known as caloric testing, results in nystagmus, rapid eye movements that can help a physician analyze a balance disorder. Abnormal results on this test can be a sign of Meniere's disease. Since tumor growth can produce symptoms similar to Ménière's disease, an MRI is a useful test to determine whether a tumor is causing the patient's vertigo and hearing loss.

Additional tests done to distinguish Meniere's disease from other causes of vertigo may include:
 * Evoked potential studies
 * Electronystagmography
 * Head CT scan or head MRI scan
 * Hearing tests (audiology/audiometry)

Treatment options
There is no cure for Ménière's disease. The goal of treatment is to reduce pressure in the inner ear and relieve symptoms. The symptoms of the disease are often controlled successfully by reducing the body’s retention of fluids through dietary changes (such as a low-salt or salt-free diet and no caffeine or alcohol) or medication. Water pills (diuretics) may help relieve fluid pressure in the inner ear. Changes in medications that either control allergies or improve blood circulation in the inner ear may help. Eliminating tobacco use and reducing stress levels are more ways some people can lessen the severity of their symptoms.

Different surgical procedures have been advocated for patients with persistent, debilitating vertigo from Ménière's disease. Labyrinthectomy (removal of the inner ear sense organ) can effectively control vertigo, but sacrifices hearing and is reserved for patients with nonfunctional hearing in the affected ear. Vestibular neurectomy, selectively severing a nerve from the affected inner ear organ, usually controls the vertigo while preserving hearing, but carries surgical risks. Recently, the administration of the ototoxic antibiotic, gentamycin directly into the middle ear space has gained popularity worldwide for the control of the vertigo of Ménière's disease.

Medications such as antihistamines, anticholinergics, are used but are rarely effective.

Medicines called antiemetics may be prescribed for nausea and vomiting. Symptoms such as dizziness, and vertigo may respond to sedative/hypnotics and benzodiazepines such as diazepam.

Hearing aids may be needed for severe hearing loss.

Avoid sudden movements that may aggravate symptoms. You may need help walking due to loss of balance during attacks.

Avoid bright lights, TV, and reading during attacks, which may make symptoms worse. Rest during severe episodes, and gradually increase activity.

Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until 1 week after symptoms disappear.

Diseases with similar symptoms

 * Vertigo
 * Superior canal dehiscence syndrome

Where to find medical care for Ménière's disease?
Directions to Hospitals Treating Meniere's disease

Prevention of Ménière's disease
There is no known prevention for Meniere's disease, but prompt treatment of ear infection and other related disorders may be helpful.

What to expect (Outlook/Prognosis)?
The outcome varies. Meniere's disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

Possible complications

 * Inability to walk or function due to uncontrollable vertigo
 * Hearing loss on the affected side