Menieres Disease

What is Meniere’s disease?

Meniere’s disease is a rare disorder of the inner ear which causes:

1. Episodes of vertigo.
2. Tinnitus, ringing in the ears and fullness or pressure in the ear.
3. Fluctuating hearing loss during attacks with progressive hearing loss in the affected ear over time.

It is a very over diagnosed condition, and no-one can be diagnosed with Meniere’s disease without all three of these symptoms. It more commonly affects one ear but can affect both ears.

Drop attacks or unexplained sudden falls, may occur in a very small number of patients. 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 although following an attack it may take one or two days for the symptoms to disappear completely.

During Meniere’s episodes several attacks may occur within a short period of time. However, years may pass between episodes.

About one in 2000 people develops Meniere’s disease. It can occur at all ages, and most frequently starts between ages of 20 and 50 years.

Initially the disease usually affects one ear, but 15 percent of people will have both ears affected.

Although an acute attack can be incapacitating, the disease itself is not fatal but in some cases can affect quality of life.

In 60 to 80 percent of people with Meniere’s disease, the symptoms will improve and disappear after two to eight years. However, some people will be left with permanent hearing loss, tinnitus, or both. In around 40 percent of people the hearing loss affects both ears.

What is the cause?

The underlying cause is unknown, but it is thought that a build up of fluid in the labyrinth from time to time can cause the symptoms.

Many factors are probably involved in the development of the disease.

It has often been put down to viral infections of the inner ear, head injury, a hereditary predisposition (15 percent of patients have a family history of Meniere’s disease), and allergy.

Migraine may cause symptoms that overlap with Meniere’s disease in 40 percent of cases.

How is the diagnosis made?

The diagnosis is usually based on the patient’s history of typical symptoms.

Several hearing tests done over time will confirm the diagnosis. The diagnosis may also only become clear over time as the typical pattern of recurring attacks develops.

Other conditions can cause similar symptoms to Meniere’s, and these will be excluded by the Ear Nose and Throat team. For example: injury, infection, or a growth affecting the inner ear.

Vestibular Migraine is also commonly seen in people with Menieres disease and can mimic many of the same symptoms.

What tests are there?

A hearing test will be done, and may be repeated over time. Simple clinic balance tests will be done. Occasionally scans and other specific tests may be done but not in every case.

Is there a cure?

At the present time there is no cure for Meniere’s disease, but there are ways to manage the condition and help control symptoms.

How do I manage an attack?

During an acute attack:

If you have been given medication to reduce vomiting and nausea take it as soon as you are aware of the attack coming on.

• Lay down on a firm surface. Stay as still as possible, with your eyes open and fixed on a stationary object
• Stay like this until the severe vertigo (spinning) passes, and then get up slowly
• After the attack subsides, you’ll probably feel very tired and need to sleep for several hours.

What is the medical management?

• Make a specific diagnosis of MD
• Suggest any medication that may help
• Diet and lifestyle changes may be recommended hours
• Audiologists will assess and help with hearing loss and tinnitus, providing hearing aids as needed, white noise generators to help with tinnitus, and tinnitus counselling where necessary
• Specialised physiotherapy (vestibular rehabilitation) maybe needed if there is a balance problem in between attacks. Some patients may need counselling to help with anxiety associated to Meniere’s disease.

Medication

Medication used can be divided into two groups:

• Drugs aimed at controlling acute vertigo and vomiting during the attacks eg. prochlorperazine (Stemetil) and cinnarizine (Stugeron).
• Drugs aimed at reducing the frequency and severity of attacks eg. Betahistine (Serc).

Treatment to help hearing loss

Hearing aids are important for all people with hearing loss, whether it is in one ear (unilateral) or both ears (bilateral) and the audiology team will look after this.

What treatment helps tinnitus?

Various white noise generators, which help mask the tinnitus, are available as well as retraining and counselling. 

Diet and lifestyle

Whilst there is little scientific evidence to prove that diet and lifestyle can help, our patient experience has led us to advise:

• There is limited evidence for a low salt diet
• Stopping smoking if you are a smoker
• Regular exercise and methods to combat stress
• Looking for food triggers. For example, cutting out caffeine (found in tea, coffee, cola, and chocolate etc.) and alcohol may be worth trying
• Treatment for any stress, anxiety and/ or depression.

What surgical treatment helps?

This is only indicated when a patient is incapacitated with unilateral Meniere’s disease and quality of life is affected because these interventions are irreversible. The surgeon would aim to use the least invasive procedure from the following options:

• Intratympanic steroid injections to settle inflammation
• Gentamicin perfusion of the inner ear to deaden the affected ear with vestibulotoxic medication
• Vestibular neurectomy, cutting the balance nerve on the affected side
• Labyrinthectomy the semicircular canals and balance nerve is surgically cut away

How can I adapt my lifestyle to better manage the condition?

Reducing stress and regular relaxation can help you cope with anxiety. Most people cope well with their symptoms once they have a clear diagnosis and advice on self management. You may find further information useful from:

• The Menieres Society
• The Royal National Institute for Deaf and Hard of Hearing People (RNID) has a fact sheet about Meniere’s disease
• NHS UK - Meniere's desease

Other useful telephone numbers and contacts

• NHS Direct 111

How to contact us Physiotherapy Gym Southport Centre for Health and Wellbeing 42-44 Hoghton St Southport, PR9 0PQ Tel: 01704 385 069

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