Meniere disease (MD) is a chronic disorder of the inner ear that affects both hearing and balance. This condition is characterized by spontaneous, recurrent episodes of vertigo, accompanied by a fluctuating hearing loss, ringing in the ear, and a sensation of ear fullness. While the exact cause of Meniere disease remains unknown, its symptoms are linked to an abnormality in the inner ear’s fluid system.
The Inner Ear Mechanism of Meniere Disease
The physical manifestation of Meniere disease is endolymphatic hydrops, an excessive buildup of endolymph fluid within the inner ear’s membranous labyrinth. The inner ear contains the cochlea (responsible for hearing) and the vestibular system (which manages balance), both of which are filled with endolymph.
Excessive endolymph volume distends the labyrinth, housing the sensory hair cells that detect sound and motion. This increased fluid pressure interferes with the function of these sensory cells, disrupting signaling between the inner ear and the brain. This disruption leads to the characteristic symptoms of hearing loss and disequilibrium.
This fluid imbalance results from either the overproduction or under-resorption of endolymph, though the precise cause is not fully understood. The condition typically affects only one ear initially, but bilateral involvement can develop over time.
The Episodic Nature of Primary Symptoms
The hallmark of Meniere disease is the sudden, episodic nature of its four primary symptoms, often referred to as a tetrad.
- Vertigo: This is the most disruptive symptom, a severe spinning sensation that can last from 20 minutes up to 24 hours. Attacks are often accompanied by intense nausea, vomiting, and sweating.
- Fluctuating Sensorineural Hearing Loss: This often precedes or accompanies vertigo episodes. Early in the disease, it frequently affects lower-frequency sounds and may improve between attacks, but it can become more permanent over time.
- Tinnitus: This is the perception of sound, such as ringing or buzzing, in the affected ear.
- Aural Fullness or Pressure: This is described as a feeling of congestion or blockage deep within the affected ear.
In a small fraction of patients, a severe, acute manifestation known as Tumarkin’s otolithic crisis, or drop attack, can occur. This is a sudden loss of postural stability causing the person to fall abruptly without losing consciousness.
Potential Contributing Factors and Attack Triggers
The exact origin of Meniere disease is idiopathic, meaning it arises from an unknown cause. Research suggests underlying factors contribute to its development, including genetic predisposition (roughly 10% of cases are familial), viral infections (like herpes simplex), autoimmune responses, or prior head trauma.
Specific triggers are known to precipitate acute episodes. Dietary triggers that influence fluid balance are frequently cited, including high intake of salt and caffeine. Alcohol and tobacco smoke are also recognized triggers because they can affect inner ear fluid dynamics and circulation. Systemic stressors like emotional stress, fatigue, and allergies are commonly reported factors that can initiate an attack.
Medical and Lifestyle Management Strategies
Since there is no known cure for Meniere disease, treatment focuses on managing acute attacks, reducing episode frequency and severity, and minimizing long-term functional loss. Lifestyle modifications are foundational, aiming to stabilize inner ear fluid volume.
Lifestyle Modifications
Adopting a low-sodium diet (typically 1,500 to 2,000 milligrams per day) is recommended to decrease fluid retention. Limiting or eliminating intake of caffeine, alcohol, and nicotine is also advised due to their vasoconstrictive effects, which can impede blood flow to the inner ear. Stress reduction techniques and ensuring adequate sleep are important non-pharmacological methods, as stress and fatigue can act as attack triggers. Physical therapy, known as vestibular rehabilitation, helps the brain compensate for chronic balance issues between episodes.
Medical and Invasive Treatments
For acute vertigo episodes, medications such as vestibular suppressants and antiemetics are used to alleviate the spinning sensation, nausea, and vomiting. Long-term control often involves diuretics, or “water pills,” which reduce overall body fluid volume and inner ear pressure.
If conservative measures fail, more invasive treatments may be considered. These options include intratympanic injections of corticosteroids or the antibiotic gentamicin, which chemically ablates the balance function of the affected ear to stop vertigo. Surgical procedures like endolymphatic sac decompression or vestibular nerve sectioning are reserved for patients with debilitating, refractory symptoms.