Ménière’s Disease

FLUID IMBALANCE OF THE INNER EAR.

Ménière’s disease, also called endolymphatic hydrops, is a disorder of the fluid balance in the inner ear. Its cause is unknown, but it is one of the most common reasons for dizziness originating in the inner ear. Often, only one ear is involved, but both ears may be affected in from 15 to 50 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Women appear to be affected slightly more often than are men.

Symptoms

The classical symptoms of Ménière’s disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Tinnitus and fullness of the ear in Ménière’s disease may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches can develop in time. Loud sounds may be uncomfortable and seem distorted in the affected ear.

Of all the Ménière’s disease’s symptoms, vertigo is usually the most troublesome. It may last for 20 minutes to two hours or longer. During vertigo attacks, patients are usually incapacitated and unable to perform activities normal to their work or home life. Dysequilibrium or imbalance and generalized tiredness may follow for several hours and even days. The symptoms of Ménière’s disease may be only a minor nuisance or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.

Treatment

A low salt diet and a diuretic (water pill) is usually the first-line treatment and will reduce the frequency and severity of attacks of Ménière’s disease in many patients. In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed. Anti-vertigo medications may also provide temporary relief, and are to be used only during vertiginous attacks, as both anti-vertigo and anti-nausea medications may cause drowsiness and delay proper recovery.

Patients should also avoid caffeine, smoking, and alcohol, get regular sleep, and eat properly. Remain physically active but avoid excessive fatigue. Since stress may aggravate the vertigo and tinnitus of Ménière’s disease, stress avoidance or counseling may be advised. In cases of bilateral Ménière’s disease, you will be advised to undergo a detailed evaluation for food and other environmental allergies. If you are found to have such allergies, avoidance or other treatment will result in a dramatic reduction of your Ménière’s symptoms. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. As such, you may have to forego ladders, scaffolds, and use of heavy machinery until your Ménière’s disease is under better control. Eighty to 85% of patients’ symptoms are controlled for long periods of time with dietary modifications and medication. Only 15 to 20 percent of patients will need more aggressive interventional therapy, such as surgery.