In Meniere disease, pressure and volume changes of the labyrinthine endolymph affect inner ear function. The etiology of endolymphatic fluid buildup is unknown. Risk factors include a family history of Meniere disease, preexisting autoimmune disorders, allergies, trauma to the head or ear, and, very rarely, syphilis. Peak incidence is between ages 20 and 50.
Meniere disease is an inner ear disorder that causes vertigo, fluctuating sensorineural hearing loss, and tinnitus. There is no reliable diagnostic test. Vertigo and nausea are treated symptomatically with anticholinergics or benzodiazepines during acute attacks. Diuretics and a low-salt diet, the first line of treatment, often decrease the frequency and severity of episodes. For severe or refractory cases, the vestibular system can be ablated with topical gentamicin or surgery.
Symptoms and Signs
Patients with Meniere disease have sudden attacks of vertigo that usually last for 1 to 6 hours but that can (rarely) last up to 24 hours, usually with nausea and vomiting. Accompanying symptoms include diaphoresis, diarrhea, and gait unsteadiness.
Tinnitus in the affected ear may be constant or intermittent, buzzing or roaring; it is not related to position or motion. Hearing impairment, typically affecting low frequencies, may follow. Before and during an episode, most patients sense fullness or pressure in the affected ear. In a majority of patients, only one ear is affected.
During the early stages, symptoms remit between episodes; symptom-free periods may last > 1 year. As the disease progresses, however, hearing impairment persists and gradually worsens, and tinnitus may be constant.
Treatment
There is no cure for Ménière's disease, so treatment focuses on managing symptoms. Different types of medications may be used to control various symptoms, including:
Anti-vertigo medications, such as meclizine (Antivert or Bonine) or betahistine, to relieve or prevent vertigo and dizziness
Antinausea medications, such as prochlorperazine (Compazine), to relieve nausea and vomiting
Diuretics, such as hydrochlorothiazide (HydroDIURIL), to reduce the amount of fluid that builds in the inner ear
Many physicians also recommend avoiding caffeine, alcohol, salt and nicotine to reduce the frequency or severity of attacks. These lifestyle changes may or may not help, but they are worth trying.
In severe cases, your doctor may recommend injections of gentamicin into the middle ear. A side effect of gentamicin is damage to the balance mechanism inside the ear. By selectively destroying the balance part of the ear, the condition may actually improve. Single to multiple injections may be necessary to damage the inner ear enough to stop the vertigo episodes. The injections can be performed in the office.
Your doctor may recommend surgery if symptoms of vertigo are severe or frequent. Different surgical procedures are available, each with pros and cons. For example, some types of surgery require your doctor to destroy parts of the inner ear, which can cause permanent hearing loss. If you are considering surgery, be sure to talk to your doctor about the possible risks and benefits. Surgical procedures that may be recommended in severe cases include:
Selective vestibular neurectomy, in which the nerve that runs from the inner ear to the brain is cut
Endolymphatic shunt, in which a tiny hole is cut in the inner ear to help clear out some of the accumulated fluid
No treatment can prevent the hearing loss that occurs in Ménière's disease. It is usually difficult to ignore an attack of Ménière's disease. See your health care professional if you experience an unexplained spinning or dizzy sensation or if you experience hearing loss.
