Definition

Meniere's disease is a disorder of the labyrinth in the inner ear. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.

The Inner Ear

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Causes

An increase in the volume or pressure of fluid in the labyrinth can result in Meniere's disease. The cause of these fluid changes is unknown. Possible causes may include:

    
  • Part of the labyrinth ruptures, allowing fluid in different compartments to mix
  • Scar tissue causes a blockage in the labyrinth
  • Inner ear injury due to:     
  • Viral infection
  • Syphilis , a sexually-transmitted disease
  • Autoimmune disorders
  • Blood vessel problems
  • High cholesterol or other fats in the blood
  • Hormonal disorders
  • Medications, such as antibiotics and chemotherapy agents

    • Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Meniere's disease include:

        
  • Age: 20 to 60
  • Race: Caucasian
  • Family history of Meniere's disease
  • Stress
  • Allergies
  • Excess salt in the diet
  • Excess noise

    • Symptoms

    The intensity of symptoms can vary from one person to another. Symptoms usually come on suddenly. They typically involve only one ear, but may involve both.

    Symptoms may include:

        
  • Episodes of vertigo (spinning sensation), often accompanied by:     
  • Nausea or vomiting
  • Sweating
  • Paleness of the skin
  • Weakness or falling
  • In some cases, headache or diarrhea
  • Hearing loss may worsen during attacks of vertigo
  • Tinnitus (ringing in the ears)
  • Feeling of fullness or pressure in the ear
  • Poor sense of balance
  • A tendency for symptoms to worsen with movement

    • Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include an examination of your ears and a neurologic exam to evaluate for possible nerve damage.

    Tests may include:

        
  • Blood tests—to check for an underlying cause
  • Hearing test —this is also called an audiometry
  • Electronystagmogram—a type of eye movement test
  • Auditory brainstem response—measures electrical activity in the hearing nerve and brain stem
  • Electrocochleogram—measures electrical response of the inner ear to sound
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the ear

    • Treatment

    Treatment may include:

    Dietary and Lifestyle Changes

    These may help limit symptoms:

        
  • Bed-rest during acute attacks of vertigo
  • Avoid foods that are high in salt and high in sugar
  • Drink adequate fluids
  • Promptly begin replacing fluids lost to heat or exercise
  • Avoid caffeine, aspirin, and smoking
  • Minimize stress
  • Avoid medications that seem to bring on or worsen symptoms
  • Consider a hearing aid, if necessary
  • Consider masking devices (white noise) to limit the effects of tinnitus
  • Take safety measures to avoid falling
  • Restrict chocolate consumption
  • Reduce alcohol intake

    • Vestibular Exercises (Vestibular Rehabilitation)

    Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

    Medications

    Medications include:

        
  • Drugs to treat vertigo, such as meclizine or scopolamine
  • Antiemetics—medications to help control nausea
  • Other medications that may improve hearing, control inner ear swelling, or limit overall symptoms, including:     
  • Antihistamines
  • Cortisone drugs for a short time
  • Antidepressants or anti-anxiety medications
  • Diuretics
  • Aminoglycoside therapy (such as streptomycin or gentamicin) to permanently destroy the part of the inner ear that deals with balance

    • Surgery

    Surgical procedures are not always helpful, and include:

        
  • Endolymphatic sac decompression—removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
  • Labyrinthectomy—destruction or removal of the entire inner ear, which controls balance and hearing
  • Vestibular nerve section

    • Prevention

    There are no specific guidelines for preventing Meniere's disease. However, to help reduce your risk, avoid the following risk factors:

        
  • High-salt diet
  • High-sugar diet
  • Excess noise
  • Excess alcohol
  • Stress
  • Smoking
  • Use of drugs that can be toxic to the ear such aminoglycosides, aspirin, and quinine