What is Ménière’s Disease?

This is a disorder affecting the inner part of the ear and characterised by sudden attacks of vertigo (spinning), tinnitus and deafness.

What is the cause?
The cause is unknown. It is thought to be due to increased pressure of fluid inside the canals of the balance-controlling organ in the ear. Normal functioning of the nerves associated with hearing and balance is affected.

What are the symptoms?
The pattern of attacks varies between sufferers. Some people experience clusters of attacks, others may have only one a year. Sufferers experience four classic symptoms varying in severity from mildly annoying to totally disabling in an acute attack.
* Fluctuating hearing loss – usually in one ear and getting worse with time.
* Fluctuating tinnitus – a noise in one ear for no real reason. It varies in intensity and type from high or low pitched buzzing, to a sound of rushing water. It can stop sleep at night.
* Fluctuating sense of fullness – a “plugged ear” sensation in one ear. For many it is like descending from a mountain and being unable to “clear” the pressure.
* Fluctuating vertigo – an attack of dizziness may come out of the blue and last for some hours or days. You may need to hold on to someone. It may be mild or severe and accompanied by a spinning sensation, and may lead to sudden bouts of nausea and vomiting. Headaches may also occur.

Triggers
Many patients report that a sudden attack may be triggered by the ingestion of salty food like pizza, or drinking caffeine or alcohol or simply stress, allergies and even pregnancy.

How is it diagnosed?
There is no specific test. The doctor will discuss the symptoms and then confirm or eliminate causes for them. Finally when all else has been excluded, the symptoms are called “Ménière’s disease. Some of the following tests may be carried out.
* A basic hearing test – to assess the extent of hearing loss. This loss may fluctuate and the results need careful interpretation.
* Vertigo is induced by warm or cold air introduced to the outer ear – the patient’s eye movements are then observed.
* Electrocochleogram (ECoG) and Auditory brainstem response (ABR) and MRI-these are diagnostic tests carried out on the head.

What is the treatment?
Many cases are treated and managed with varying degrees of success. No one treatment seems to work for everyone. It may take a while to find out which works for you. During an attack you should stay as still as possible, preferably lying down in a darkened room and afterwards get some rest. Treatments found to alleviate the symptoms are:
* Dietary and lifestyle – many patients report a strong link between salt ingestion and onset or worsening of symptoms. They use low salt recipes to reduce the salt intake. Diuretics are often prescribed in conjunction. Doctors will tell you it is important to rest and keep a low stress life-style. Specific exercise routines have been designed to improve balance skills. Reduced alcohol, caffeine and nicotine intake are recommended.
* Herbal and Vitamin – gingko biloba and niacin (vit B3) are each thought to be a vasodilator that improves blood flow to the head and relieves symptoms, but overdoses can cause organ damage. Check with your pharmacist about any possible interaction with medication you are already taking; similarly for ginger root tea to help counteract nausea.
* Medication – SERC (Betahistine hydrochloride) is widely available on prescription and can reduce the frequency, duration and intensity of vertigo attacks. Other effective drugs prescribed are valium to reduce vertigo, phenergan as a rectal suppository to reduce nausea, lidocaine nasal drops to reduce tinnitus, and dramamine to help vertigo.
. * Surgical – mostly to relieve severe vertigo where attacks persist. Using a local anaesthetic, a surgeon will inject a drug through the eardrum (tympanic membrane). For persistent attacks an operation can be carried out to relieve the pressure on the inner ear or block the transmission of information by nerves from affected ear to brain.

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