Ménière disease is a chronic condition affecting the inner ear. This disorder is characterized by recurrent and unpredictable episodes that can significantly impact an individual’s quality of life.
Understanding the Symptoms
The experience of Ménière disease is largely defined by four classic symptoms. Vertigo, a severe spinning sensation, is a prominent symptom and can last anywhere from 20 minutes to 24 hours. This intense dizziness is frequently accompanied by nausea, vomiting, and sweating.
Alongside vertigo, individuals often experience tinnitus, the perception of ringing, buzzing, roaring, or hissing sounds in the affected ear. This internal noise can fluctuate in intensity. Hearing loss is another hallmark symptom, typically affecting low frequencies and fluctuating, especially during or after an attack. Over time, this hearing loss can become permanent.
Completing the quartet of symptoms is aural fullness, a feeling of pressure or blockage within the affected ear. Not every individual experiences all symptoms with the same intensity during every episode.
Exploring Causes and Risk Factors
The cause of Ménière disease is unknown, but the leading theory is endolymphatic hydrops. This is an abnormal buildup of endolymph, a fluid in the inner ear’s labyrinth, which interferes with balance and hearing signals.
While endolymphatic hydrops is observed, the reason for fluid accumulation is often unclear, classifying it as idiopathic. However, several factors are thought to contribute to its development, including an abnormal immune response that may damage inner ear structures, and viral infections.
Genetic predisposition also appears to play a role, with approximately 7-10% of affected individuals having a family history. Head trauma and certain underlying conditions like migraine headaches or allergies have also been identified as potential contributing factors.
Diagnosing the Condition
Diagnosing Ménière disease relies on reported symptoms and a physical examination. No single definitive test exists, making a detailed medical history important. Diagnostic criteria from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) help classify definite or probable Ménière disease.
Hearing tests, specifically audiometry, are routinely performed to assess hearing loss patterns consistent with Ménière disease. These tests measure how well an individual hears sounds at various pitches and volumes, often revealing difficulty with low frequencies. Audiograms provide objective evidence of hearing impairment.
Balance tests, such as videonystagmography (VNG) or electrocochleography (ECoG), may evaluate inner ear function. These tests assess balance system function and help rule out other conditions. Imaging studies, such as MRI scans, are primarily used to exclude other causes, such as tumors.
Approaches to Management
No cure exists for Ménière disease, so management focuses on controlling symptoms and improving quality of life. Lifestyle modifications are often the first approach, aiming to reduce inner ear fluid retention. This commonly involves a low-salt diet and avoiding caffeine, alcohol, and nicotine. Stress management and adequate sleep can also reduce symptom frequency and severity.
Medications address acute attacks and long-term prevention. During acute vertigo episodes, anti-vertigo medications like meclizine or diazepam can suppress the spinning sensation. Anti-nausea medications like ondansetron or promethazine also alleviate associated nausea and vomiting. For long-term management, diuretics like hydrochlorothiazide or acetazolamide may reduce inner ear fluid pressure. Betahistine, widely used internationally, can reduce vertigo frequency.
Various therapies can assist with coping and recovery. Vestibular rehabilitation therapy involves exercises to help the brain and body adapt to balance deficits, useful between attacks or for chronic imbalance. Counseling or psychotherapy can support individuals experiencing anxiety or depression related to the disease’s unpredictable nature.
For severe cases unresponsive to conservative treatments, intratympanic injections may be considered. Corticosteroids like dexamethasone can be injected into the middle ear to reduce inflammation and vertigo. Gentamicin, an antibiotic, can also be injected; it damages balance-sensing hair cells to control vertigo, but carries a risk of permanent hearing loss. Surgical interventions are last resorts for severe, debilitating cases. Procedures like endolymphatic sac decompression relieve pressure, while a vestibular nerve section cuts the nerve to prevent balance signals from reaching the brain. Labyrinthectomy, which removes parts of the inner ear, is considered when there is significant or complete hearing loss, as it results in total hearing loss in that ear.