Also known at endolymphatic hydrops, Meniere’s disease affects both the balance and hearing function of the inner ear. The cause is unknown. One commonly purported theory is that attacks of Meniere’s disease are triggered by excess accumulation of fluid known as endolymph in the inner ear. However, other factors such as viral infections, allergy, head trauma, and genetic predisposition have all been proposed. One or both ears can be affected, either concurrently or at different times in life. The disease usually initially presents sometime between 20 and 50 years of age.
A classic attack of Meniere’s disease includes a sense of fullness in the ear often with associated ringing, a sudden drop of hearing in the ear, and significant vertigo. The vertigo is typically described as a sensation of the room spinning and can be severe enough to cause nausea and vomiting. Most Meniere’s attacks will last at least 20-30 minutes but commonly can persist for hours. Many patients find they have to simply lay down and try to sleep off the attack. After the vertigo symptoms resolve, the other ear symptoms can persist for days afterwards. The frequency of attacks is extremely variable, from once yearly, to several per week. The frequency can also change over time with symptoms becoming more or less prominent. Over time, the continued attacks tend to cause progressive hearing loss in the affected ear(s). This hearing loss can be quite profound with an extended course of Meniere’s disease. In many patients, the disease will persist for 5-10 years before “burning out” with attacks dissipating. Unfortunately, the hearing loss does not recover. Therefore it is very important to treat with preventative measures to preserve hearing in the involved ear.
There is no specific test to confirm the diagnosis of Meniere’s disease. Much of the diagnosis is determined by the history presented by the patient. A hearing test can be helpful and often shows that hearing is worse in the low frequencies. An MRI is typically ordered to ensure there is no other inner ear problem as the cause of symptoms. Some ancillary testing such as electrocochleography and videonystagmography can sometimes be helpful.
Initial treatment focuses on prevention strategies. Patients are advised to maintain a low sodium diet and avoid triggers such as caffeine and alcohol. Stress and anxiety can contribute to Meniere’s disease and should be managed as best as possible. Many times a water pill, or diuretic, will be offered with the idea of trying to limit the accumulation of endolymph in the inner ear. Medications can be given that can help to abort an attack once the patient begins to feel symptoms. Beyond these measures, the next step usually involves a trial of steroid injections to the inner ear. In refractory cases, antibiotics can be injected into the ear to ablate the balance system in the affected ear so the brain will no longer receive faulty information from that side. Very rarely, more invasive surgical techniques can be offered.