What you need to know about Ménière’s disease

Ménière’s disease causes vertigo, tinnitus and progressive deafness. There is no remedy but the symptoms can be relieved by certain therapies.

Roughly 615,000 individuals in the United States have Ménière ‘s disease, according to the National Center on Deafness and Other Communication Disorders (NIDCD). This may occur at any age but it occurs more often between the ages of 40 and 60. It affects, in most situations, only one leg.

In this article, we describe Ménière ‘s disease signs, causes, and triggers, as well as natural and traditional treatments. We also suggest changes in diet that can help a person reduce the symptoms.

Treatment

A Ménière’s disease woman

Although there is no remedy, certain symptoms can be treated with medication.

Lifestyle changes

Ménière ‘s disease has links to stress and anxiety. However, it is unknown if stress and anxiety are causing Ménière’s disease symptoms, or if the disease is causing stress and anxiety.

Nonetheless, controlling stress and anxiety can help reduce symptom severity. People can find that yoga, meditation, tai chi or focus helps them to relax.

Evidence indicates there is a link between smoking and tinnitus, and quitting will help to reduce the symptoms.

Medications for vertigo

Doctors may prescribe different types of vertigo drugs. Possibilities include:

  • Motion sickness drugs: These medications include meclizine (Antivert) and diazepam (Valium). They can help with the spinning sensation that vertigo causes, as well as the nausea and vomiting.
  • Drugs for nausea: Prochlorperazine (Compazine) is an effective medication for treating nausea during an episode of vertigo.
  • Diuretics: These drugs reduce fluid retention in the body. For Ménière’s disease, doctors might prescribe a combination of triamterene and hydrochlorothiazide (Dyazide or Maxzide).

Reducing the amount of fluid stored by the body will increase the volume of fluid and the pressure inside the ear. As a consequence, symptom intensity and frequency will diminish.

Middle ear injections

Doctors can inject some medicine into the middle ear to improve vertigo symptoms.

Other medications include gentamicin (Garamycin) antibiotics, and steroids such as dexamethasone (Decadron).

Surgery

If other treatments have not been effective, or if symptoms are severe, surgery may be an option for people with Ménière ‘s disease. Surgical options include:

  • Endolymphatic sac decompression: A surgeon removes a small portion of bone from around the endolymphatic sac. This membrane in the inner ear helps control water pressure in the ear. If it is not working correctly, this may contribute to vertigo.
  • Labyrinthectomy: A surgeon removes a portion of the inner ear.
  • Vestibular nerve section: A surgeon cuts the vestibular nerve.
  • Vestibular rehabilitation therapy: People may experience balance problems between episodes of vertigo. A healthcare professional can instruct them on exercises and activities that may help their body and brain regain the ability to process balance.

People with hearing loss may benefit from a hearing aid.

Alternative treatment

While making diet and lifestyle changes, there are few natural choices available for treating the Ménière disease.

Some herbs, including ginger root and ginkgo biloba, can give some people relief from symptoms of vertigo.

However, no evidence supports the use of herbal supplements, acupuncture, or acupressure to treat Ménière’s, according to the NIDCD.

Herbal additives can also interfere with existing medicinal products. Those who want to test out these treatments should consult with a doctor before they are taken.

Positive pressure treatment

A few years ago, a system that can benefit people with Ménière ‘s disease was approved by the Food and Drug Administration ( FDA)

This system releases tiny air pressure pulses into the middle ear. To minimize dizziness these stimuli tend to connect with the fluid within the ear.

Symptoms

Symptoms of Ménière ‘s disease differ from person to person. They can happen unexpectedly, and vary in frequency and duration.

Doctors also call unexpected signs an attack. Attacks at Ménière differ in duration but usually last from 20 minutes to 24 hours.

Popular symptoms suffered during an attack include:

Vertigo

Usually the most obvious symptom of Ménière’s disease, vertigo can involve:

  • a spinning sensation, even while a person is stationary
  • dizziness
  • vomiting
  • nausea
  • irregular heartbeat
  • sweating

It’s hard to tell when there will be a vertigo attack. That’s why it’s important to always have vertigo medicine handy.

Symptoms of vertigo can affect many activities including:

  • driving
  • operating heavy machinery
  • climbing ladders or scaffolding
  • swimming

Tinnitus

This persistent, disruptive noise in the ear may resemble the following sounds:

  • ringing
  • buzzing
  • roaring
  • whistling
  • hissing

People are generally more aware of it during quiet times or when they are tired.

Hearing loss

In a person with Méniére ‘s disease, hearing loss rates that fluctuate, especially early in progression of the disease.

The person may be more sensitive to loud noises, too. Most people with Ménière’s gradually experience a degree of long-term hearing loss.

Anxiety, stress, and depression

Due to Ménière ‘s disease these psychological symptoms can also evolve. The condition is unpredictable, and can adversely affect the ability of the person to work, especially if they have to climb ladders or operate machinery.

As listening increasingly gets worse, people can find social interaction more difficult.

Many people with Ménière’s lose their driving capacity, further restricting their independence, work opportunities, mobility, and access to friends and family. Telling your doctor is vital to people who experience stress, anxiety or depression.

Ménière’s can have other symptoms all over the body as well. In the section below we’ll discuss these in more depth.

Stages

Disease of Ménière occurs in two stages. A person can not experience symptoms for prolonged periods between those stages.

Early

Ménière ‘s disorder triggers unexpected and recurrent bouts of vertigo in its early stages.

There will be some hearing loss during these episodes which usually returns to normal after the vertigo subsides. The ear may feel cramped and blocked, and feel complete or pressurized. Tinnitus is also normal in Ménière ‘s disease in the early stages.

An individual also has severe fatigue after a vertigo attack due to Ménière ‘s disease, and feels the need to sleep for hours.

In the early stages of the disease people can also experience the following:

  • diarrhea
  • blurry vision
  • jerking eye movements
  • nausea
  • vomiting
  • cold sweat
  • palpitations or a rapid pulse
  • trembling

Late

By the late stages of the disorder, vertigo symptoms get less frequent and, in some cases, never return.

Problems with balance, hearing, and vision will continue though. If it’s dark, individuals will feel particularly dysfunctional. Hearing and tinnitus continue to get ever worse.

A person may experience drop attacks, too. Some include losing posture unexpectedly, or falling down abruptly while staying conscious.

Complications

Ménière’s most damaging trait is the unexpected occurrence of vertigo attacks.

The individual may have to lie down and miss out on social events, recreation, work, or family.

Vehicle licensing authorities in many countries suggest people living with Ménière ‘s disease will not be driving.

Such authorities won’t allow the person to drive until they get assurances from a doctor that their symptoms are under control.

Diet

Some dietary changes can help to decrease fluid retention. In general, reducing the concentration of fluid can reduce the symptom frequency and severity.

These measures may help:

  • Eating more frequent but smaller meals: Evenly distributing meals throughout the day helps regulate body fluids. Rather than eating three large meals a day, try six smaller ones.
  • Eating less salt: The less salt a person consumes, the less fluid their body will retain. People should avoid adding salt to meals and cut out most junk foods, as these are often high in added salt.
  • Reduce alcohol intake: Alcohol can adversely affect the volume and composition of the inner ear fluid.
  • Drink water regularly: Peoples with Ménière’s disease should take particular care to hydrate regularly during hot weather and intense exercise.
  • Avoid tyramine: This amino acid is in a range of foods, including chicken liver, smoked meats, red wine, ripe cheeses, nuts, and yogurts. It may trigger migraine, and people with Ménière’s disease should consider avoiding foods that contain it.

Causes

Ménière’s disease can occur because of an abnormality in the inner ear structure or the amount of fluid inside it.

The exact reason these changes are occurring, however, is unclear.

The inner ear comprises a network of passages and cavities linked, called the labyrinth.

The outer part of the inner ear has the bony labyrinth as its refuge. Inside, there is a flexible membrane structure with a similar shape which is a smaller version of the labyrinth.

The membraneous labyrinth contains an endolymph fluid. This also has hair-like sensors that respond to the movement of the fluid, and via nerve impulses send signals to the brain.

In various forms of sensory perception different parts of the inner ear play functions such as:

  • detecting acceleration in any direction
  • rotational motion
  • sound

The pressure, volume, and chemical composition of the fluid must be right for all sensors within the inner ear to operate completely.

Other characteristics of the Ménière disease change the inner ear fluid properties, causing the disease’s disorienting effects.

Triggers

Some stresses and emotional disturbances can cause episodes of Ménière ‘s symptoms, including overwork, underlying health problems, and fatigue.

Salt in the diet is another trigger.

Diagnosis

No single examination or scan will permit diagnosis of Ménière ‘s disease by a doctor. The doctor will perform an interview and physical examination, will inquire about the medical and family history of the person and will identify the signs and symptoms.

The doctor will ask about the following:

  • the severity of symptoms
  • how often symptoms occur
  • what medications the person has been taking
  • any previous problems with the ears
  • general health status
  • any history of infectious diseases or allergies
  • any family history of inner ear problems

Several other diseases and conditions have similar symptoms, which can make it challenging to diagnose Ménière’s disease.

Hearing loss

A doctor must administer an audiogram to assess the extent of hearing loss.

An audiometer generates tones of varying pitch and loudness. The person listens with headphones and demonstrates when they hear a sound or when there is no sound any more.

Balance assessment

A number of people with Ménière ‘s disease experience a degree of balance difficulty. A person’s sense of balance between episodes of vertigo can appear to resolve.

Electronystagmography

A doctor introduces warm, cool water or air into the ear canal. In response to this simulation, they then calculate the involuntary eye movements. Unusual responses may indicate an inner ear problem.

Rotary chair testing

The person sits on a chair in a small , dark booth. The doctor positions electrodes above the person’s eyes, and a computer-led chair slowly rotates at various speeds back and forth.

The motion activates the mechanism of internal equilibrium and induces nystagmus, or eye movements. A computer and monitor records these with an infrared camera.

Vestibular evoked myogenic potentials (VEMP) testing

This test measures the function of certain sensors in the inner ear that detect acceleration.

Posturography

The individual wears a safety harness while standing barefoot on a special platform and trying to keep their balance under various conditions.

Other tests

A doctor may want to rule out other possible conditions and diseases including a brain tumor or multiple sclerosis (MS). To help them do this they can ask for the following scans:

  • MRI scan
  • CT scan
  • Auditory brainstem response audiometry — which measures ear and brain function in response to sounds — to rule out tumors

Summary

The condition of Ménière has a wide spectrum of symptoms, and is difficult to diagnose and treat.

Attacks may be regular or rare and cause pain, anxiety and loss of hearing. Remission cycles occur in between episodes.

A person with Ménière ‘s disease will seek medical care, as there are many strategies for controlling the symptoms.

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