Meniere's Disease

Definition

Meniere's disease or syndrome is a condition characterized by hearing impairment, ringing in the ears (tinnitus), and periodic vertigo (disturbance of balance and equilibrium).

Description

Meniere’s disease results from distention of the endolymphatic compartment of the inner ear. This finding, endolymphatic hydrops, is also found in diseases other than Meniere's.

Causes and Risk Factors

Although a precise cause of hydrops cannot be found in most cases, two well known causes are head trauma and syphilis.

Symptoms

Meniere's disease is characterized by symptoms that include: episodic vertigo (feeling like the room is spinning) lasting up to 8 hours, fluctuating hearing loss, a feeling of fullness in the ear, and tinnitus (ringing in the ear).

The tinnitus is usually low-pitched and blowing in quality. The hearing loss is more severe in the lower frequencies, frequently progresses over many years, and remains confined to one ear in most patients. The attacks may be associated with nausea and vomiting.

Diagnosis

A reliable diagnosis can be made from history alone when there is a clear-cut symptom triad: characteristic vertigo; tinnitus; and fluctuating, unilateral hearing loss.

Approximately 75 percent of patients also report a sensation of fullness in the affected ear or ears.

Treatment

Many authorities today initially recommend a multifactorial approach, with general attention given to overall physical and mental well-being, proper diet, salt restriction (less than 2 grams of sodium daily), avoidance of known triggers, and stress management. Some patients may require diuretics (“water pills”) to help control symptoms by reducing pressure in the ear.

Various symptomatic approaches are used, depending on the severity of the patient's vertigo and nausea. For mild symptoms when the person tries to continue normal activities, dimenhydrinate (Dramamine) or meclizine HCI (Antivert) may be used.

Various other medications may also be used for symptomatic relief, although not specifically indicated for Meniere's disease. These include transdermal scopolamine patches (Transderm Scop); promethazine HCI (Phenergan), an antihistaminic, antivertiginous medication used for more severe attacks, and diazepam (Valium).

Surgery is generally reserved for patients with intractable, intolerable vertigo or tinnitus, or to prevent further deterioration of hearing. The decision to operate depends on the age of the patient and the degree of hearing loss.

Smoking cessation is advisable when applicable, though the specific contribution of smoking or nicotine is a controversial issue. Some authorities believe that there may be a direct influence, and there are reports of complete clearing of symptoms when smoking is eliminated.

Questions to Ask Your Doctor

What treatment will you be recommending?

How long does it take to see results?

Are there any medications that help relieve or stop an attack? What are the risks or complications?

How effective are they?

Will surgery be required?

What are the risks or complications?