Ménière’s Disease

What is Ménière’s disease?

Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or pressure in the ear.

The symptoms of Ménière’s disease are caused by the excessive buildup of fluid in the compartments of the inner ear which contain the organs of hearing and balance. Parts of the inner ear are filled with a fluid called endolymph that stimulates receptors in our balance system as the body moves. The receptors then send signals to the brain about the body’s movement. For hearing, this fluid is compressed in response to sound vibrations, which stimulates sensory cells that send signals to the brain. In Ménière’s disease, the fluid buildup interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality causes vertigo and other symptoms of Ménière’s disease. Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Ménière’s disease usually affects only one ear.

Why do people get Ménière’s disease?

Many theories exist about what happens to cause Ménière’s disease, but no definite answers are available. Some researchers think it is the result of constrictions in blood vessels and others think Ménière’s disease could be a consequence of viral infections, allergies, head injury or autoimmune reactions. Because Ménière’s disease appears to run in families, it could also be the result of genetic variations that cause abnormalities in the regulation of endolymph fluid.

How is Ménière’s disease diagnosed?

Ménière’s disease is most often diagnosed and treated by an Otolaryngologist (ENT). However, there is no definitive test or single symptom that a doctor can use to make the diagnosis. Diagnosis is based upon your medical history and the presence of:

Two or more episodes of vertigo lasting at least 20 minutes each
Tinnitus (noises in the ear)
Temporary hearing loss
A feeling of fullness in the ear

Some doctors will perform a hearing test to establish the extent of hearing loss caused by Ménière’s disease. To rule out other diseases, a doctor also might request magnetic resonance imaging (MRI), computed tomography (CT) scans of the brain and/or balance testing.

How is Ménière’s disease treated?

Ménière’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

The most disabling symptom of an attack of Ménière’s disease is dizziness. Prescription drugs such as Meclizine, Diazepam, and Lorazepam can help relieve dizziness and shorten the attack.
Salt restriction and diuretics. Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.
Pressure pulse treatment. The FDA recently approved a device for Ménière’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness.
Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.
Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
Alternative medicine. Although scientists have studied the use of some alternative medical therapies in Ménière’s disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as gingko biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies, since they sometimes impact the effectiveness or safety of conventional medicines.

Coping with Ménière’s Disease

Coping with Ménière’s disease can be challenging because attacks are unpredictable and some of the symptoms are not obvious to others. Successfully coping with symptoms involves understanding the disease. Key features of communicating with family and friends include informing them about what might happen with the onset of an acute attack and how they can help. If a low-sodium diet is effective, family and friends should be informed about how important it is for them to support adherence to the diet regimen. Changes in lifelong eating patterns can be easier with the assistance of others.

Managing an acute attack involves preparation. This includes consulting with a physician about any appropriate drugs that can be taken when an acute attack occurs. During an attack, it is helpful to lie down in a safe place with a firm surface, and avoid any head movement. Sometimes keeping the eyes open and fixed on a stationary object about 18 inches away is helpful.

Where can I find additional information about Ménière’ disease?

NIDCD maintains a directory of organizations that can answer questions and provide printed or electronic information on Ménière’s. Please see the list of organizations at www.nidcd.nih.gov/directory.

Ménière’s Disease