Meniere’s disease is a chronic disorder of the inner ear characterized by recurring episodes of vertigo, fluctuating hearing loss, tinnitus (ringing in the ear), and a sensation of aural fullness. This condition is thought to be caused by an excessive build-up of fluid, called endolymph, within the inner ear’s balance and hearing structures. Successful management requires a multidisciplinary approach, drawing on the expertise of several specialized medical professionals to address the condition and its varied symptoms.
The Primary Medical Specialist: Otolaryngology and Neurotology
The primary specialist responsible for the diagnosis and medical management of Meniere’s disease is an Otolaryngologist (ENT physician). Patients are often referred to a Neurotologist, an ENT physician with additional fellowship training focused on complex inner ear and balance disorders. This specialist oversees the overall care plan.
The diagnostic process involves a physical exam and specialized tests to confirm the condition and rule out other causes of dizziness or hearing loss. Audiometry, a hearing test, is essential to document the fluctuating sensorineural hearing loss, particularly in the low-to-mid frequency range, which is characteristic of Meniere’s. Balance function is assessed using tests like Videonystagmography (VNG) or Electronystagmography (ENG), which measure eye movements to gauge inner ear function.
Initial medical management focuses on reducing inner ear fluid pressure to control vertigo attacks. This begins with lifestyle modifications, such as limiting sodium intake, since salt contributes to fluid retention. Diuretics are commonly prescribed maintenance medications to help the body excrete excess fluid and lessen the severity of episodes. During an acute vertigo attack, medications like meclizine or benzodiazepines may be used to suppress the spinning sensation and control associated nausea.
Therapeutic Support for Symptoms: Audiology and Vestibular Rehabilitation
While the medical specialist manages disease progression, other specialists address chronic symptoms like hearing loss and imbalance. The Audiologist monitors and manages the hearing-related effects of Meniere’s disease. They perform regular audiograms to track the severity and fluctuating nature of the hearing loss.
The audiologist helps select and fit appropriate hearing aids or assistive listening devices to improve communication. Since hearing loss can be asymmetrical, they may recommend specialized devices like a Contralateral Routing of Signals (CROS) system. CROS systems transmit sound from the poor-hearing ear to a receiver in the better-hearing ear, restoring sound localization and clarity.
For patients experiencing chronic dizziness or unsteadiness, a Vestibular Rehabilitation Therapist (VRT), typically a specialized Physical Therapist, provides targeted therapy. Vestibular rehabilitation is an exercise-based program that helps the brain compensate for the damaged inner ear balance system.
Exercises include habituation training, which reduces the brain’s sensitivity by repeated exposure to symptom-provoking movements. The therapist also uses gaze stabilization exercises, such as focusing on a target while moving the head, to improve eye and inner ear coordination. This therapy enhances overall balance, reduces fall risk, and improves stability for daily activities, especially after acute vertigo attacks are controlled.
Interventional and Surgical Treatment Options
When conservative management fails to control debilitating vertigo, the Neurotologist considers more invasive procedures. These treatments are divided into non-destructive and destructive options, based on their effect on remaining hearing function.
Non-Destructive Interventions
A common non-destructive intervention is an intratympanic injection, where medication is delivered directly into the middle ear space for absorption into the inner ear. Steroids, such as dexamethasone, are injected to reduce inflammation and control vertigo with a lower risk of affecting hearing. Another approach is endolymphatic sac decompression, a surgical procedure that relieves pressure in the inner ear fluid system while preserving hearing.
Destructive Interventions
If vertigo remains severe, destructive options are considered as a last resort. Intratympanic gentamicin injections are used because this antibiotic is toxic to the inner ear’s balance cells, intentionally stopping vertigo by reducing the function of the affected ear. While highly effective for vertigo control, this procedure carries a known risk of worsening hearing loss.
The most invasive surgical procedures include vestibular neurectomy and labyrinthectomy, both performed by a Neurotologist. A vestibular neurectomy involves selectively cutting the balance nerve to spare the hearing nerve. A labyrinthectomy removes the inner ear balance organ entirely and is reserved only for patients who already have non-functional hearing in the affected ear, as it results in complete hearing loss.