What is Meniere’s disease?
Meniere’s disease results from a problem in the inner ear. Patients suffer attacks of spinning dizziness, hearing loss, tinnitus and a feeling of pressure in the ear. It usually affects one ear more than the other although in some people it can become a problem in both ears. 1 in a 1000 people is affected by Meniere’s Disease. It is commoner in women.
What are the symptoms of Meniere’s disease?
- Fluctuating hearing.
- Vertigo which is a sensation of movement often a spinning sensation. Usually associated with nausea/feeling sick or vomiting.
- Tinnitus which is a ringing or buzzing sound.
- Pressure in the ear.
The important thing is that these symptoms come together during an attack. The attack can last from 20 minutes to many hours. It is unusual for an attack of Menieres to last more than a day although you may feel unsteady for a few days. You may experience several attacks in quick succession over several days and then have a period of remission. Occasionally the hearing loss and tinnitus may become permanent.
What causes Meniere’s disease?
The exact cause is not known.The fluid spaces of the inner ear become swollen.This may be related to problems in the area where the fluid is normally absorbed (endolymphatic sac). The diagnosis of usually based on the story/history and excluding other causes of dizziness. A scan may be carried out to exclude other causes of dizziness.
Many patients with Meniere’s disease also have a history of migraine. A common cause of recurrent dizziness is migraine associated vertigo. The main difference is the presence of hearing loss in Meniere’s disease. Indeed migraine and Meniere’s disease share a number of symptoms including nausea, dizziness, pressure/pain and tinnitus. The cause of migraine as in Meniere’s disease is unknown. Other conditions often coexisting with migraine include irritable bowel syndrome, TMJ dysfunction (pain in jaw), fibromyalgia and chronic fatigue syndrome. Some of these conditions also have dizziness as one of their features. Many patients on close questioning may have had bouts of pain in their head, neck, ear or sinuses either in the past or present. In addition patients often have a family history of the above problems. It might be that Meniere’s and migraine (and possibly the other conditions listed above) are manifestations of the same underlying condition.
What treatment can I take during an attack?
During an attack you may wish to take something to stop you feeling nauseous such as prochlorperazine (can be given in a tablet which can be placed under the lip which is useful if the nausea is causing you to vomit) or cinnarizine. Stop taking the medicine after the attack. Long-term use of these medications can cause other problems and may not help your Meniere’s. Some patients seem to benefit greatly from prochlorperazine (Stemetil). These patients may be suffering from migraine associated vertigo where prochlorperazine is recognised as a way of treating the problem. Nevertheless it is not recommended that this is taken on a long-term basis.
Preventing attacks of vertigo
Lifestyle changes include:
- Reduce your salt, caffeine and alcohol intake
- Reduce/ stop smoking
- Reduce stress
- Increase your exercise. Walk half an hour a day
- It is recommended you remain well hydrated. Research carried out showed drinking 35ml/kg water per day reduced attacks. This equates to nearly 2.5 litres per day for a 70 kg “average” man.
- Lack of sleep or too much sleep can act as a trigger.
Some patients may benefit from exercises to allow them to recover after each attack as described in the section on vestibular neuronitis (Click here). This is only practical if the attacks are fairly incapacitating and infrequent.
Betahistine is a drug often used to help patients with Menieres. It increases the blood flow around the inner ear. It does not work in all cases. In some people diuretics (e.g. Bendroflumethiazide)or beta-blockers may be helpful. In some patients where there is evidence of migraine or migranous features (eg pains in the head and neck area, sensitivity to light or sound, past history of migraine or bilateral problems with normal hearing) standard migraine treatments may be of benefit. Please see here.
Intra-tympanic therapy/injection can be very effective. This involves anaesthetising the ear drum with cream for 30 minute followed by an injection through the ear drum into the middle ear. The patient then has lie head down for 30 minutes. Clearly one ear would need be identified as causing the problem. The medication used include methyl-prednisolone, dexamethasone or gentamicin. One or more injection may be required to achieve control. Success can not be guaranteed. There are potential risks including hearing loss, tinnitus, dizziness, perforation of the ear drum and failure. Gentamicin is associated with higher risk of hearing loss.
In some cases surgery may be considered. These include minor surgery such as Grommets to more major surgery.
Drivers with Meniere’s disease must tell the Driver and Vehicle Licensing Agency (DVLA). If you have attacks of disabling vertigo/dizziness with no warning then you should not drive.
Further help and information
The Ménière”s Society
The Rookery, Surrey Hills Business Park, Wotton, Dorking, Surrey, RH5 6QT
Helpline: 0845 120 2975
British Tinnitus Association
Ground Floor, Unit 5, Acorn Business Park, Woodseats Close, Sheffield, S8 0TB
Tel (Freephone): 0800 018 0527
RNID Tinnitus Helpline
19-23 Featherstone Street, London, EC1Y 8SL
Helpline: 0808 808 6666 (voice) 0808 808 0007 (text)
Comprehensive patient resources are available at www.patient.co.uk