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Meniere's Disease - Causes, Symptoms, Diagnosis, and Management

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Meniere's Disease - Causes, Symptoms, Diagnosis, and Management

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Meniere's disease is a vertigo-inducing inner-ear ailment. Continue reading the article below to learn more about this.

Written by

Dr. Shikha

Medically reviewed by

Dr. Akshay. B. K.

Published At July 26, 2022
Reviewed AtJanuary 31, 2023

What Is Meniere's Disease?

Meniere's disease is an inner-ear disorder that can induce vertigo, a sort of dizziness that makes one feel like they are spinning. The innermost region of your ear is the inner ear. The inner ear has two distinct functions. It converts sound into electrical signals (nerve impulses). The brain can hear and understand sound as a result of this. Balance is also maintained by the inner ear.

It can also produce a ringing sensation in the ears (tinnitus), fluctuating hearing loss, and a sensation of fullness or pressure in the ear. Only one ear is usually impacted, and hearing loss can become permanent over time.

A French doctor, Prosper Meniere, proposed in the year 1860s that the symptoms were caused by the inner ear instead of the brain, as most people thought, and hence the condition was named after him.

What Are the Causes of Meniere's Disease?

The etiology of Meniere's illness is unknown, with no specific explanation for the changes developed due to the disease. Still, scientists believe they do not have a good understanding of how the symptoms develop.

Meniere's disease can be caused by abnormalities in the inner ear's structure or fluid levels. Fluid builds up inside the labyrinth, a portion of the inner ear that houses structures that aid in hearing and balance. The volume, pressure, and chemical composition of the fluid must be correct for all the sensors present in the inner ear to function properly. The additional fluid causes dizziness and hearing issues by interfering with the messages the brain receives.

It is unclear why people develop Meniere's disease. However, scientists have a few suggestions about what might be affecting the fluid in the inner ear:

  • Allergic reaction or infection to the inner ear.

  • Autoimmune responses by the body.

  • Hereditary conditions or family history of the disease.

  • Viral infections.

  • Head injury or blow to the head leading to a concussion.

  • Migraines.

  • Side effects of any medication.

  • Drainage issue with the inner ear due to blockage or abnormal structure.

  • Alcohol or smoking.

  • Stress and anxiety.

  • Tiredness or fatigue.

What Are the Symptoms of Meniere's Disease?

Meniere's disease is a progressive disease, meaning it worsens over time. It may begin slowly, with random hearing loss. Later on, vertigo may appear. People who have Meniere's disease usually experience:

  • Ringing and buzzing noises in the ear or tinnitus.

  • Dizziness with a sensation of spinning or vertigo.

  • Nausea and vomiting.

  • Vision can get blurred.

  • Feeling a trembling sensation and being unsteady to walk.

These symptoms usually occur simultaneously and can last for minutes or hours, but they usually last two to three hours. The illness normally begins in one ear, although it can eventually extend to both. The symptoms may take a day or two to go away completely. After an episode, you may feel exhausted. The signs and symptoms vary from person to person, although hearing loss without vertigo is unusual. Attacks might occur in clusters or multiple times each week, or they can occur weeks, months, or years apart.

Meniere's disease is most common in adults between the ages of 20 to 60, and it is a rare occurrence in children.

How Is Meniere's Disease Diagnosed?

Meniere's disease cannot be diagnosed with a single test or scan. The doctor will do an interview and physical examination, inquire about the patient's family and medical history, as well as evaluate the signs and symptoms. The doctor will prescribe tests to check the balance and hearing and rule out other possible reasons.

  • Audiometry or a hearing test is performed to evaluate whether or not the patient has hearing loss based on their volume (intensity) and the rate at which sound waves vibrates. An audiometer is an electronic device that produces pure tones, the intensity of which can be increased or decreased. Usually, air conduction and bone conduction of sound are measured at varied frequencies. The amount of intensity of sound that has to be raised above the normal level is a measure of the degree of hearing impairment at that frequency. It is charted in the form of an audiogram.

  • Electronystagmogram (ENG) or balance tests determine how well the inner ear is working. Meniere's disease patients have a decreased balancing response in one of their ears. Electrodes are placed around your eyes to detect eye movement. It is performed because the inner ear's balancing reaction generates eye movements. Both hot and cold water will be forced into the ear during this test. The water activates the balancing system, and unintentional eye movements will be monitored. Any anomalies in the inner ear can suggest a concern.

  • Electrocochleography (ECoG) test measures electrical activity in the inner ear. Hearing loss can be caused by a problem with the inner ear or the ear nerve.

  • The auditory brainstem response (ABR) test evaluates the function of the auditory nerves and the brain's hearing center. These tests can inform the doctor whether the issue stems from the inner ear or ear nerve.

  • The vestibular-evoked myogenic potential (VEMP) test measures the sound sensitivity of the vestibule, that is, the response to sudden loud noises.

  • Posturography testing can assist in figuring out which element of your balancing system is not working properly. This will put your balance to the test and see how well you can maintain it. You will be asked to stand barefoot on a platform that can move in any direction. The doctor will be able to observe how the patient reacts when the platform moves in certain ways while wearing a safety harness.

  • Rotary chair testing will show the doctor whether the condition is caused by an ear problem or a brain problem. Since electronystagmogram results can be wrong if one has an ear injury or wax covers one of the ear canals. The eye movements are meticulously recorded while the chair moves in this exam.

  • The doctor can request a magnetic resonance imaging (MRI) of the head or a cranial computed tomography (CT) scan to assess any potential brain issues since the symptoms comparable to Meniere's disease can also be caused by brain problems such as multiple sclerosis (MS) or brain tumors.

How to Manage and Treat Meniere's Disease?

Meniere's disease is a chronic ailment that has no known cure. However, a variety of therapies are available to relieve the symptoms, ranging from medicine to surgery in the most difficult situations.

  • Medication

Motion sickness medications can help with vertigo, and antiemetic or anti-nausea drugs help with nausea and vomiting. The doctor may prescribe a Diuretic to help reduce the amount of fluid in the body, as Meniere's disease is believed to be caused by a fluid issue in the inner ear.

The doctor may prescribe Gentamicin, an antibiotic that has a slight adverse effect on the inner ear. It disables the damaged ear's function, allowing your "good" ear to take over the balance of the body.

  • Physical Therapy

Vertigo symptoms can be improved with vestibular rehabilitation activities. Immediately lie down or sit if one feels dizzy. Do not perform any activity that may induce vertigo. Do not attempt to drive. These exercises aid in the training of the brain to account for the balancing differences between the two ears. A physical therapist can offer a set of exercises to undertake on a regular basis to help with difficulties like imbalance, dizziness, and other problems. Staying active and obtaining exercise, such as walking, might also help.

  • Surgery

Surgery could be an option for those who have severe symptoms and have failed to respond to previous therapies. A technique called an endolymphatic sac procedure is used to reduce the fluid production and facilitate fluid outflow in the inner ear. Cochleosacculotomy is a surgical procedure for the development of a fistula between the saccule and the cochlear duct and can help in removing fluid from the ear.

Conclusion:

Meniere's illness is difficult to detect and treat due to its wide spectrum of symptoms. Attacks can be severe or mild, causing worries, anxiety, and hearing loss. Between incidents, there are remission periods. A person suffering from Meniere's illness should seek medical help, as there are numerous ways to treat the symptoms.

Frequently Asked Questions

1.

What Are the Symptoms of Meniere's Disease?

The symptoms of Meniere's disease are vertigo, a sensation of spinning, tinnitus a type of ringing or buzzing sound that does not have an external source, hearing loss, increased pressure in the ear, sense of fullness in the ear, headache, nausea, blurring of vision, and abdominal pain.

2.

What Are the Diagnostic Tests for Meniere's Disease?

Diagnosis is made on examination of symptoms such as hearing loss, sense of fullness in the ear, or tinnitus; audiometry, a hearing test that evaluates the hearing loss. It can also be diagnosed by electronystagmogram (ENG), a balance test done to the inner ear, an electrocochleography (ECoG) test to measure the electrical activity of the inner ear, an auditory brainstem response (ABR) test to evaluate the function of the auditory nerve which helps in perceiving sound. Other tests include rotary chair testing to confirm whether it's an ear or a brain problem and a magnetic resonance imaging (MRI) or computed tomography (CT) scan of the head to evaluate any presence of tumors. 

3.

Can Meniere's Disease Be Treated?

There is no cure for Meniere’s disease. Even if the disease goes away for months, it will always come back. However, the symptoms can be managed by using medications, physical therapy, or by surgical treatment. 

4.

What Is the Best Treatment for Meniere's Disease?

The best treatment for Meniere's disease includes the use of medications such as diuretics which decreases the amount of fluid in the body, therefore decreasing inner ear fluids. Diuretics are used as long-term medications and can reduce the number of vertigo attacks and stabilize hearing. Other medications, such as antiemetic for motion sickness medications, can be used to treat nausea and vomiting.

5.

Can Meniere's Disease Cause Serious Issues?

Meniere’s disease does not cause any life-threatening conditions or serious issues, but it can affect the quality of life. Individuals with this disorder can get affected by the symptoms without any warning, which can disrupt their life, and they may develop anxiety and depression by worrying about future attacks.

6.

Is Meniere's Disease Treated by a Neurologist or ENT Specialist?

Meniere’s disease is an inner ear disorder that affects hearing and balance. An otolaryngologist, also known as an ear-nose-throat (ENT) specialist, diagnoses and treats Meniere’s disease. At the same time, a neurologist can identify the cause of vertigo, whether it is related to central or peripheral causes. Peripheral vertigo can occur due to Meniere’s disease.

7.

Can a Neurologist Treat Meniere’s Disease?

One of Meniere’s symptoms includes vertigo which is the sensation of spinning. Neurologists often treat vertigo, and before treatment, the cause has to be identified. Vertigo can be due to a problem in the inner ear called peripheral vertigo or a problem in the cerebellum of the brain called central vertigo. When the specific cause of vertigo is identified, and the reason is Meniere's disease, suitable treatment is given.

8.

What Is the Last Stage of Meniere's Disease?

There are three stages of Meniere’s disease. In the first stage, the hearing levels return to normal after the attacks. In the second stage, the hearing levels do not return to normal. In stages 1 and 2, the sounds become distorted, and these effects are reversible, but over time they can cause permanent damage. In the third or last stage, there can be severe hearing loss below 60 dB HL (decibel hearing level) and can occur in both ears. 

9.

How to Treat Meniere's Disease Naturally?

Minere’s disease has no cure, but the symptoms can be treated. Naturally, the symptoms can be reduced by diet change, which includes low salt that helps reduce the pressure in the inner ear, using bottled water, which does not contain salt as water softeners. Also, avoiding alcohol, and caffeine, quitting smoking, avoiding allergic triggers by using anti-allergic medications, and getting plenty of sleep can reduce stress. 

10.

Can an Individual with Meniere's Disease Live a Normal Life?

Meniere's disease does not cause a life-threatening condition, and it is not fatal, but it is a chronic illness that can affect the person’s daily activities of life. The symptoms or attacks can happen at any time and can last for 20 minutes or up to two hours. Individuals may develop depression or anxiety thinking about future attacks.  

11.

Can Meniere's Disease Affect the Brain?

No, Meniere’s disease does not affect the brain but affects the sound signals that are sent to the brain. The part of the inner ear called the labyrinth has an organ of balance and hearing and has two sections called bony and membranous labyrinth. The build-up of fluid called endolymph in the membranous labyrinth interferes with the hearing signals and balance, therefore causing hearing problems, vertigo, and other symptoms of Meniere’s disease.

12.

What Diet Changes Should Be Made for Individuals with Meniere's Disease?

The diet should include a low-sodium diet because this helps in reducing the pressure in the inner ear. This can be achieved by cutting off extra salt in the food, including foods that have low salt content, such as frozen or fresh vegetables, fruits, chicken, turkey, and fish and also, by checking the labels for salt content before buying. Avoiding canned foods, processed foods, such as smoked meats, packaged foods, olives, pickles, soy sauce, most cheeses, bottled salad dressing, and most snack foods. Other things include using salt-free seasoning while cooking at home, using fresh herbs, avoiding foods that contain monosodium glutamate (MSG, a flavor enhancer), and avoiding spices that contain salt. 

13.

Can an MRI Help in Diagnosing Meniere's Disease?

Yes, using a high-contrast magnetic resonance imaging (MRI) scan, the endolymphatic hydrops, which gets build-up in the membranous labyrinth of the inner ear, can be detected. This build-up of fluid affects the hearing signals and balance, therefore causing the symptoms of Meniere’s disease. 

14.

How Can Meniere's Disease Be Prevented?

Meniere's disease can affect anyone but likely occurs at the age of 40 to 60 years. The symptoms of this disease can be reduced by intake of low salt in the diet, avoiding coffee, alcohol, and smoking, managing stress, and managing allergic symptoms. And also by the use of medications such as diuretics (Hydrochlorothiazide-Triamterene), anti-vertigo (Betahistine), antihistamines, and anti-nausea drugs.

15.

Can Ayurvedic Treatment Help in Curing Meniere's Disease?

There is no cure for Meniere's disease, but it involves many things to reduce the symptoms. In ayurvedic treatment, a therapy called panchakarma is used, which uses five methods and helps in cleansing the tissues, removing toxins, managing stress, and decreasing deep-rooted anxiety. Other things that are included in the ayurvedic treatment are lifestyle changes such as physical exercises, proper rest, and intake of medicated milk and meat soups. 

16.

What Is the Best Vitamin to Improve the Symptoms of Meniere's Disease?

According to studies, vitamin D has a role in immunomodulating by stimulating or suppressing the immune system and helps in regulating pro-inflammatory mediators. Therefore, the intake of vitamin D supplements helps in improving the symptoms of Meniere’s disease.

17.

What Is the Homeopathic Cure for Meniere's Disease?

Homeopathic treatment for Meniere's disease can provide relief from the symptoms for a long period. Homeopathic medications that are used are Chininum Sulph, Phosphorus, Chenopodium, Gelsemium, Theridion, Cocculus Indicus, and Natrum Salicylicum. 
Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)

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meniere’s diseaseinner ear problem
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