Topic Overview
What is Ménière's disease?
Ménière's (say "men-YEERS") disease is an
inner ear problem that affects your hearing and balance.
The
disease usually occurs in people ages 40 to 60. It affects both men and women.
Rarely, children also can have Ménière's disease.
What causes Ménière's disease?
The cause of
Ménière's disease is not known. It may be related to fluids that build up in
the inner ear.
What are the symptoms?
Ménière's disease can cause
symptoms that come on quickly. During a Ménière's attack, you may have:
- Tinnitus, a low
roaring, ringing, or hissing in your ear.
- Hearing loss, which may
be temporary or permanent.
- Vertigo, the feeling that you or your surroundings are
spinning.
- A feeling of pressure or fullness in your ear.
An attack can last from hours to days. Most people have
repeated attacks over a period of years. Attacks usually become more frequent
during the first few years of the disease and then come less often after
that.
How is Ménière's disease diagnosed?
To diagnose
the disease, your doctor will do a physical exam and ask you questions about
your past health. Hearing tests or other tests, such as an
MRI, may be done to make sure you don't have other
conditions.
How is it treated?
Treatment helps control your
symptoms, such as vertigo. Medicines for the inner ear may be used to reduce
the spinning feeling of vertigo. Other medicines may help the nausea or
vomiting caused by vertigo.
Some people may be able to have fewer
attacks by:
- Eating a low-salt diet.
- Using medicines (diuretics) to get rid of extra fluids.
- Doing exercises to improve balance.
- Avoiding
caffeine, alcohol, tobacco, and stress.
Doctors sometimes use surgery to relieve the symptoms of
Ménière's disease. But surgery can damage your hearing, so it is usually used
only after all other treatments have not worked.
Frequently Asked Questions
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Cause
The cause of
Ménière's disease is not known, but it may be related
to a fluid imbalance in the inner ear.
The
inner ear contains a fluid called endolymph. It is thought that, in Ménière's
disease, too much of this fluid builds up in the inner ear. The resulting
pressure affects the
sensory systems in the inner ear that help maintain
balance. This leads to the symptoms of
tinnitus (ringing in the ears), hearing loss,
vertigo (spinning sensation), and pressure or fullness
in the ear.
Little is known about the cause of endolymph fluid
buildup. It may be that too much fluid is produced or that the fluid does not
properly drain from the inner ear, or it may be a combination of the
two.
Symptoms
Symptoms of
Ménière's disease are:
- Vertigo attacks that occur suddenly and
last from several minutes to hours. The spinning sensation caused by vertigo is
often bad enough to cause nausea, vomiting, and dizziness.
- A low-pitched
roaring, ringing, or hissing sound in the ear (tinnitus).
- Hearing loss (often of
low-frequency sounds) that may return to normal after the attack or may be
permanent.
- A feeling of pressure or fullness in the ear.
Vertigo is not the same as feeling dizzy. Dizziness is
feeling unsteady or unstable. Vertigo is a sensation of whirling or spinning.
Symptoms of dizziness and vertigo may be caused by many conditions other than
Ménière's disease.
Sometimes you may sense that an attack is about
to occur. The signal might be:
- An increasing feeling of pressure in the
ear.
- Sounds seeming louder than normal.
- Nausea. A few
people have nausea before an attack. But nausea can have many causes, so nausea
does not always mean that an attack is about to occur.
- Dizziness.
What Happens
An attack of
Ménière's disease causes symptoms of
tinnitus (ringing in the ears), hearing loss, a
feeling of pressure or fullness in the ear, and
vertigo (spinning sensation).
The attacks
are unpredictable and vary in frequency and severity. An attack can last from
hours to days. Most people have repeated attacks over a period of years.
Attacks usually increase in frequency during the first few years of the disease but then decrease in frequency.
Vertigo may be severe and result
in nausea and vomiting. To reduce this feeling, try lying perfectly still until
the attack subsides.
Sometimes each additional attack damages the
inner ear. Over time the inner ear may become so badly damaged that it may no
longer function properly. The attacks will then usually stop, but you may
have:
- Poor balance.
- Permanent hearing
loss.
- Residual roaring or hissing in the affected ear.
Ménière's disease normally occurs in only one ear at a
time. In as many as half of the people affected, the disease eventually
develops in the other ear.1
A few people
with Ménière's disease experience "drop attacks." A drop attack is a sudden
fall while standing or walking. The falls occur without warning. And the
attacks are described as suddenly being pushed to the ground. There is
no loss of consciousness, and complete recovery occurs in seconds or minutes.
What Increases Your Risk
Because the cause of
Ménière's disease is unknown, it is difficult to
predict who will get the condition. You may be at higher risk for getting
Ménière's disease if you have:
- Another family member who has this
condition.
- An
autoimmune disease (such as diabetes, lupus, or
rheumatoid arthritis), which occurs when the
immune system attacks the body.
- Had a head
injury, especially if it involved your ear.
- Had
viral infections of the
inner ear.
- Allergies. People with Ménière's
disease may be more likely to have allergies than people who do not have
Ménière's disease.
When To Call a Doctor
Call 911 or other emergency services immediately if you have
vertigo (a spinning sensation) and:
- You passed out (lost consciousness).
- You have symptoms of a stroke, such as:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
- You have chest pain.
- You have a headache, especially if you also have a stiff
neck and fever.
- You have sudden hearing loss.
- You have numbness or tingling that does not go away, anywhere on
your body.
- You have vomiting that doesn't stop.
- You had a recent head injury.
Call your doctor now or seek immediate care
if:
- You have an attack of vertigo that is different from those
you have had before or from what your doctor told you to
expect.
- You need medicine to control nausea and vomiting caused by
severe vertigo.
If you have been diagnosed with
Ménière's disease, watch closely for changes in your
health. And be sure to contact your doctor if:
- You have frequent or severe attacks of vertigo that interfere
with your normal activities.
- You do not get better as
expected.
- You have any new symptoms.
- You have problems
with your medicine.
- You have questions or concerns.
Watchful waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. Watchful waiting is not appropriate if you think you may
have Ménière's disease—see a doctor right away. Attacks of Ménière's disease
can cause permanent hearing loss. Prompt diagnosis and steps to prevent further
attacks may reduce both the discomfort of attacks and the risk of hearing
loss.
Who to see
Health professionals who can diagnose and treat
Ménière's disease include:
You may be referred to a specialist:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Your doctor can usually diagnose
Ménière's disease by asking about your
medical history and doing a
physical exam.
If the cause of your
vertigo is unclear, your doctor may want to do more
tests to determine whether your symptoms are caused by problems in the inner
ear or in the brain. Brain-related causes of vertigo (such as
stroke, head injury,
brain tumors, or
multiple sclerosis) are less common.
Other tests that may be done to rule out other causes of your symptoms
and to confirm a diagnosis of Ménière's disease include:
- Hearing tests, to detect hearing loss. A specific type
of hearing test, called an auditory brain stem response (ABR) test, may
be done to find out whether the nerve from the inner ear to the brain is
working correctly. Hearing loss supports a diagnosis of Ménière's
disease.
- Electronystagmography, which uses
electrodes to measure eye movements. It looks for characteristic eye movements
that occur when the inner ear is stimulated. The pattern of eye movements can
point to the location of the cause of the vertigo, such as the inner ear or the
central nervous system.
- Imaging tests, such as
magnetic resonance imaging of the head (MRI) or
computed tomography of the head (CT scan), which may
be done if symptoms could be caused by a brain problem.
Treatment Overview
Although
Ménière's disease cannot be cured, treatment is
available to control symptoms and reduce the frequency of attacks. During an
attack, medicines may be used to reduce
vertigo and control nausea and vomiting.
No treatment is available to prevent the hearing loss that may eventually
occur with progressive attacks of Ménière's disease.
Initial and ongoing treatment
Early and ongoing
treatment of
Ménière's disease focuses on controlling the
symptoms—especially
vertigo, a spinning sensation—and reducing the
frequency of attacks. Changing what you eat may reduce the number and frequency of
future attacks.
Treatment most often used to reduce the frequency
and severity of attacks of Ménière's disease includes:
It is important to minimize the personal safety risks
posed by Ménière's disease. For more information, see:
Vertigo: Staying Safe When You Have Balance Problems.- Vertigo: Balance Exercises.
Vertigo may be easier to tolerate if you lie down and
hold your head very still until the attack passes. Treatment during an attack of vertigo may include:
Treatment if the condition gets worse
If symptoms
of
Ménière's disease are severe and do not respond to treatment, surgery
is an option. The goal of surgery is to eliminate the symptoms of Ménière's
disease without destroying hearing in the affected ear.
In rare
cases, severe, persistent vertigo caused by Ménière's disease may be treated by
destroying the balance center in the inner ear (labyrinth) through surgery
(labyrinthectomy) or with an antibiotic injected into the ear (chemical
ablation) to destroy the labyrinth. Because these treatments may cause hearing
loss in that ear, they are typically used only as a last resort.
Prevention
In most cases,
Ménière's disease cannot be prevented. But some cases
of Ménière's disease may be caused by head injuries. Wearing a helmet when
bicycling, motorcycle riding, playing baseball, in-line skating, or during
other sports activities can protect you from head injuries that could lead to
Ménière's disease.
You may be able to reduce the frequency of
vertigo attacks by limiting the amount of salt in your
diet and avoiding caffeine, alcohol, tobacco, and stress, which can help reduce
stimulation to the inner ear. For more information on reducing salt intake,
see:
- Healthy Eating: Eating Less Sodium.
Ménière's disease may be connected to allergies. Treating
allergies with immunotherapy shots and eliminating suspected
food allergens may reduce the frequency of
attacks.2 For more information, see the topics Allergic Rhinitis and Food Allergies.
Home Treatment
The
vertigo (spinning sensation) of
Ménière's disease may be easier to tolerate if you lie
down and hold your head very still during an attack.
Changing your
diet may reduce the chance of having another attack of Ménière's disease.
Eating a diet low in salt and limiting the use of caffeine and alcohol may
reduce the frequency of attacks. But diet changes will not reduce the intensity
or duration of a vertigo attack that has already begun. For more information,
see:
- Healthy Eating: Eating Less Sodium.
Doing balance exercises and taking safety precautions for
attacks of vertigo may help. For more information, see:
- Vertigo: Staying Safe When You Have Balance Problems.
- Vertigo: Balance Exercises.
Medications
Medicines do not cure
Ménière's disease. But they can reduce the severity of
some symptoms, such as nausea, vomiting, and the spinning sensation of
vertigo. Also, medicines can help you feel more
comfortable during an attack.
Medicines that may reduce the spinning
sensation of
vertigo include:
- Antihistamines, such as dimenhydrinate
(for example, Dramamine), diphenhydramine (for example, Benadryl), and meclizine (for example, Antivert).
- Scopolamine
(Transderm Scop), which is a patch placed on the skin behind your
ear.
- Sedatives, such as clonazepam
(Klonopin) and diazepam (for example, Valium).
- Corticosteroids, such as methylprednisolone or prednisone.
Antiemetic medicines, such as promethazine, may be used to reduce nausea and
vomiting that can occur with vertigo.
Diuretics, such as hydrochlorothiazide (for example, Microzide), and a
low-salt diet may be used to reduce excess fluid and prevent future attacks of
vertigo.
Surgery
Surgery for
Ménière's disease can cause permanent damage to your
hearing. Talk with your doctor about surgical options if repeated attempts at
less invasive treatment methods have failed to relieve your symptoms. Surgery
may be considered for people with Ménière's disease who:
- Have persistent or frequent attacks of severe
vertigo (a spinning sensation) that do not improve
after using medicine.
- Have symptoms that are so debilitating that
it becomes difficult to get through the events of daily life.
- Are
affected in only one ear.
Surgeries that may be used to treat Ménière's disease
include:
- Endolymphatic sac decompression.
- Endolymphatic shunt.
- Vestibular nerve section.
- Labyrinthectomy.
The goal of surgery is to eliminate the symptoms while
keeping as much hearing in the ear as possible. But the most extreme forms of
surgery (vestibular nerve section and labyrinthectomy) always result in
complete hearing loss in that ear. The possibility of losing your hearing in
the treated ear is a major consideration when you are deciding whether to have surgery
to treat Ménière's disease. In some cases, the disease may have already greatly
damaged your hearing, which makes the risk of being deaf in that ear less
important.
Other Treatment
Other treatments for Ménière's disease can cause permanent damage to your
hearing. Talk with your doctor about your options if repeated attempts at
less invasive treatment methods have failed to relieve your symptoms.
Ménière's disease can be treated with a process called
chemical ablation, in which a toxic chemical is
absorbed into the balance center of the inner ear (labyrinth). The chemical
makes it so that the affected ear is no longer involved with balance, and
symptoms no longer occur. Hearing may be permanently damaged by this procedure. Chemical
ablation may successfully control vertigo associated with Ménière's
disease.3
The Meniett device is a
portable earpiece that sends little pulses of pressure through a small tube
into your middle ear. The result is the elimination of fluid
buildup in your inner ear, which restores your sense of balance. Initial
studies show that using this device successfully reduces symptoms of severe
vertigo in some people.4
Other Places To Get Help
Organizations
| American Hearing Research Foundation |
| 8 South Michigan Avenue |
| Suite 1205 |
| Chicago, IL 60603-4539 |
| Phone: |
(312) 726-9670 |
| Fax: |
(312) 726-9695 |
| Web Address: |
www.american-hearing.org |
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The American Hearing Research Foundation helps pay for
research into hearing and balance disorders and also helps to educate the
public about these disorders. On their website you can find general
information on many common ear disorders, including descriptions, causes,
diagnoses, and treatments. References are also included as a source for further
information. The American Hearing Research Foundation also publishes a
newsletter, available by subscription, as well as a number of pamphlets on a
variety of topics.
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| American Tinnitus Association |
| P.O. Box 5 |
| Portland, OR 97207-0005 |
| Phone: |
1-800-634-8978 |
| Phone: |
(503) 248-9985 |
| Fax: |
(503) 248-0024 |
| Email: |
tinnitus@ata.org |
| Web Address: |
www.ata.org |
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This organization provides education and a network of
services through clinics and self-help groups for patients with tinnitus. It
also publishes a quarterly newsletter.
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| National Institute on Deafness and Other Communication
DisordersNational Institutes of Health
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| 31 Center Drive, MSC 2320 |
| Bethesda, MD 20892-2320 |
| Phone: |
1-800-241-1044 |
| TDD: |
1-800-241-1055 |
| Fax: |
(301) 402-0018 |
| Email: |
nidcdinfo@nidcd.nih.gov |
| Web Address: |
www.nidcd.nih.gov |
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The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The website has information about hearing,
balance, smell, taste, voice, speech, and language.
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| Vestibular Disorders Association
(VEDA) |
| P.O. Box 13305 |
| Portland, OR 97213-0305 |
| Phone: |
1-800-837-8428 |
| Phone: |
(503) 229-7705 |
| Fax: |
(503) 229-8064 |
| Web Address: |
www.vestibular.org |
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|
This organization provides information and support for
people with dizziness, balance disorders, and related hearing problems. A
quarterly newsletter, fact sheets, booklets, videotapes, a list of other
members in your area, and information about centers and doctors specializing in
balance disorders are all available to members.
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References
Citations
- James A, Thorp M (2007). Menière's disease, search
date January 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
- Johnson J, Lalwani AK (2012). Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 729–738. New
York: McGraw-Hill.
- Storper IS (2010). Ménière syndrome. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 963–966. Philadelphia: Lippincott Williams and Wilkins.
- Gates GA, et al. (2006). Meniett clinical trial:
Long-term follow-up. Archives of Otolaryngology—Head and Neck Surgery, 132(12): 1311–1316.
Other Works Consulted
- Fife TD, et al. (2008). Practice parameter: Therapies
for benign paroxysmal positional vertigo (an evidence-based review). Report of
the Quality Standards Subcommittee of the American Academy of Neurology.
Neurology, 70(22): 2067–2074.
- Gates GA, et al. (2004). The effects of transtympanic
micropressure treatment in people with unilateral Ménière's disease.
Archives of Otolaryngoly, Head, and Neck Surgery, 130:
718–725.
- Sajjadi H, Paparella MM (2008). Meniere's disease. Lancet, 372(9636): 406–414.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
Barrie J. Hurwitz, MD - Neurology |
| Last Revised |
April 12, 2012 |
James A, Thorp M (2007). Menière's disease, search
date January 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Johnson J, Lalwani AK (2012). Vestibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, 3rd ed., pp. 729–738. New
York: McGraw-Hill.
Storper IS (2010). Ménière syndrome. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 963–966. Philadelphia: Lippincott Williams and Wilkins.
Gates GA, et al. (2006). Meniett clinical trial:
Long-term follow-up. Archives of Otolaryngology—Head and Neck Surgery, 132(12): 1311–1316.
