Understanding Meniere’s Disease – Symptoms, Stages, Treatment & More
Ménière’s disease is a chronic condition of the inner ear characterised by a triad of symptoms: episodes of vertigo (sensation of spinning), tinnitus (ringing in the ears), and hearing loss. The left ear erosion and sclerosis spread and extend beyond the oval window, causing loss of left ear hearing only. Progressive disease, left ear is usually involved; however, bilateral cases have been reported. The symptoms can come and go in unpredictable ways, which can make a big difference in the way one leads one’s life. While not life-threatening, Ménière’s disease can be both physically and emotionally draining. This blog seeks to explain Ménière’s disease in a clear and informative way – along with its symptoms and the 4 stages of disease – as well as covering diagnosis and treatment, and offers suggestions on coping with it.
What is Meniere’s Disease?
Ménière’s disease is a chronic inner ear condition that messes with both balance and hearing. It is caused by too much endolymph, a fluid that fills the labyrinth of the inner ear. This misophonia is accompanied by dysfunction of the fluid flow in hearing and balance structures that communicate with the brain. Ménière’s disease is not well understood, and the precise cause is unknown; it is generally considered a multifactorial disease.
In the UK, Ménière’s disease is quite unusual but not unknown. Approximately 1 in 1,000 people in the UK are affected, according to the Ménière’s Society. It usually occurs at ages between 20 and 60, with no significant sex predilection. There is no cure at present, but treatments can help to control and alleviate the symptoms.
What Causes Meniere’s Disease?
The exact cause of Ménière’s disease is yet not known, although many theories have been postulated. There are several widely known candidates, however:
- Alteration in fluid balance in the inner ear causing pressure changes.
- Autoimmunity, in which the immune system attacks the body’s own tissues by mistake.
- Genetic cause, as vernal keratoconjunctivitis can be hereditary.
- Viral infections of the inner ear (labyrinthitis).
It is probably a collection of these instigators that causes Ménière’s disease, rather than a single instigator. It has yet to be determined how these associations are developing further in ongoing research.
Meniere’s Disease Symptoms
Symptoms of Ménière’s disease can differ widely from person to person and fluctuate in intensity. The classic symptoms are as follows:
- Extreme vertigo, a sudden whirling or spinning sensation with intense dizziness that can last from a few seconds to minutes.
- Tinnitus, which is a ringing, buzzing, or roaring sound in the ear.
- The loss of hearing, usually temporary at first, but can become permanent.
- A sense of fullness, or pressure in the ear, sometimes preceding attacks of vertigo.
One of the most upsetting side-effects can be drop attacks, where someone falls without warning and without losing consciousness as the result of sudden loss of balance. They can be dangerous and scary, particularly in public places.
The 4 Stages of Meniere’s Disease
Ménière’s disease evolves through four stages, each characterised by certain types of symptoms and periods of time:
- Early Stage: Suddenly and out of control vertigo spells, during which hearing is usually restored to normal between spells.
- Middle Stage: Increased prevalence and severity of vertigo, increased presence and volume of tinnitus or buzzing in the ears, increased hearing loss.
- Late Stage: Attacks of vertigo become less frequent, but there is more sustained loss of hearing and tinnitus.
- Burnout Stage: The vertigo may cease altogether, but unsolvable hearing loss and balance issues often persist.
Appreciating these phases can also help patients and clinicians modulate their expectations and adjust their treatment strategies.
Meniere’s Disease Diagnosis
Diagnosing Ménière’s disease can be challenging and typically requires exclusion of alternative causes. The usual diagnostic protocol is comprised of:
- A careful history and description of the patient’s symptoms.
- Hearing tests, including audiology specific for fluctuating hearing loss.
- Equilibrium testing such as Videonystagmography (VNG) or Vestibular Evoked Myogenic Potentials (VEMP).
- Tumours or structural abnormalities can be excluded by MRI or CT scans.
Diagnosis is often based on clinical criteria plus tests taken together, because there is no one test for the condition.
Meniere’s Disease Treatment
These are just some examples, but there are many treatments that work to manage and improve quality of life with regard to the symptoms. These include:
- Medications for vertigo such as betahistine, diuretics to reduce fluid retention, and anti-nausea medications.
- Changes in diet, including consuming low-sodium foods and decreasing intake of caffeine and alcohol to manage inner ear pressure.
- Vestibular rehab therapy, which is a series of balance exercises.
- Hearing aids for people with more pronounced deafness.
- Surgery, such as endolymphatic sac decompression or labyrinthectomy, may be indicated in severe or recalcitrant cases.
Many of these treatments are NHS-led here in the UK, and the patient can see an ENT surgeon to formulate treatment which is suited to their specific issues.
Meniere’s Disease Life Expectancy
Although Ménière’s disease can be debilitating, it does not shorten life expectancy. But it can affect quality of life, mobility, and independence. Most people are able to successfully control their symptoms and live life to the fullest with continued support from medical professionals.
Living with Meniere’s Disease
When adjusting to life with Ménière’s disease, many times treatment is more of a global approach. Some useful methods are:
- Stress management, as stress can precipitate or exacerbate attacks.
- Following up with the ENT specialist to monitor progress and continue adjusting treatment.
- Connecting with support groups provides others to relate to and who have experience with coping skills and emotional support.
- Managing a severe or uncontrollable vertigo or drop attack by seeking urgent medical care.
- While difficult, lifestyle changes can have an impact on symptom management.
Conclusion
Ménière’s disease is for life, but it is manageable. Although it can affect hearing and balance, early detection and an aggressive treatment plan can help reduce its impact. If you have any unexplained dizziness, tinnitus, or hearing changes, see your GP or an ENT specialist for an evaluation. For further information, visit the NHS website.
We aim to help treat patients with chronic ear problems such as Ménière’s disease at Chase Lodge Hospital with expert care and customised treatment plans.
