Ménière’s Disease

What are the causes?

Although the cause is unknown, Meniere’s disease probably results from an abnormality in the volume of fluid in the inner ear. Too much fluid may accumulate either due to excess production or inadequate absorption.  In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménière’s disease.  In some cases, other conditions may cause symptoms similar to those of Ménière’s disease.

People with Ménière’s disease have a “sick” inner ear and are more sensitive to factors, such as fatigue and stress, that may influence the frequency of attacks.

How is a diagnosis made?

Your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:

For Hearing

• An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear.

For Balance

• An ENG (electronystagmogram) may be performed to evaluate balance function. In a darkened room, eye movements are recorded as warm and cool water or air are gently introduced into each ear canal. Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50 percent of patients, the balance function is reduced in the affected ear.
• Rotational or balance platform testing, may also be performed to evaluate the balance system.

Other Tests

• Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménière’s disease.
• The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière’s disease.

How is Ménière’s disease treated?

Although there is no cure for Ménière’s disease, the attacks of vertigo can be controlled in nearly all cases.  Treatment may include:

• A low salt diet and a diuretic (water pill)
• Anti-vertigo medications
• Intratympanic injection with either gentamicin or dexamethasone.
• Surgery

The physicians at North Fulton ENT will help you choose the treatment that is best for you, as each has advantages and drawbacks. In many people, careful control of salt in the diet and the use of diuretics can control symptoms satisfactorily.

Intratympanic injections involve injecting medication through the eardrum into the middle ear space where the ear bones reside. This treatment is done in the otolaryngologist’s office. The treatment includes either making a temporary opening in the eardrum or placing a tube in the eardrum. The drug may be administered once or several times. Medication injected may include gentamicin or corticosteroids. Gentamicin alleviates dizziness but also carries the possibility of increased hearing loss in the treated ear that may occur in some individuals. Corticosteroids do not cause worsening of hearing loss, but are less effective in alleviating the major dizzy spells.

Frequently Asked Questions

What should I do during an attack of Ménière’s disease?

Lie flat and still and focus on an unmoving object. Often people fall asleep while lying down and feel better when they awaken.

How can I reduce the frequency of Ménière’s disease episodes?

Avoid stress and excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Consult your otolaryngologist about other treatment options.