Meniere's disease
Introduction
Ménière’s disease, named after the French physician, Prosper Ménière, is a rare disorder which affects the inner ear. It is a difficult and unpredictable disease which can require different types of treatment.
Ménière's disease affects a part of the inner ear known as the labyrinth. The labyrinth is a system of tiny fluid filled channels which send signals of sound and balance to the brain. , which controls balance. Ménière's disease causes the fluid in the labyrinth to build up, disrupting both your balance and hearing.
Approximately 1 in 1,000 people develop Ménière's disease. The condition can occur at any age, but most commonly affects people who are between 20-60 years of age (it is rare for children to develop it). About 1 in 10 people may have inherited the condition, although having a relative with Ménière's disease, does not make you any more likely to develop it yourself.
Ménière's disease is a progressive condition, which means it will gradually get worse the longer you have it. The disease will normally begin by affecting one ear but, in 30% of cases, symptoms will progress to both ears. Although hearing usually returns to normal after an attack, repeated pressure increases can cause serious damage to the hearing cells which is why, in late stage Ménière's disease, hearing loss is often permanent.
Attacks of Ménière's disease may be frequent, or occur only every few months. Sometimes, they can last for several minutes, while at other times they can last for as long as 24 hours. The length and severity of attacks cannot be predicted.
The precise cause of Ménière's disease is unknown. Research suggests that it could be triggered by a variety of factors, such as an infection, or allergy. Treatment is focused on trying to ease and control the primary symptoms of vertigo, tinnitus and hearing loss.
^^ Back to top
Symptoms
The symptoms of Ménière’s disease vary from person to person. They can occur without warning, and at irregular intevals.
Primary symptoms
The three main symptoms of Ménière’s disease are outlined below.
Vertigo
Vertigo is usually the most prominent symptom of Ménière's disease. The symptoms of vertigo include:
- feeling as though you are spinning, even when standing completely still,
- dizziness,
- nausea,
- vomiting,
- palpitations (irregular heartbeats), and
- sweating.
An attack of vertigo can last for just a few minutes, but will often last for two to three hours. As it is difficult to predict when an attack will occur, keep any vertigo medication that you have to hand so that it is easily accessible. As vertigo can leave you disorientated and unbalanced, you should avoid activities such as driving, operating dangerous machinery, using ladders or scaffolding, or going swimming.
Tinnitus
Tinnitus is the perception of noise, in your ear or head, which is generated from inside your body, rather than coming from outside. It is usually more noticeable when you are tired and at quiet times when there is less background noise to distract you from the sounds tinnitus causes.
Hearing loss
Ménière's disease particularly affects the way you hear lower sounds, making them increasingly difficult to pick up. It can also make you more sensitive to loud sounds.
Menière's disease can be categorised into three stages - early stage, middle stage, and late stage - although you may not necessarily progress through each of them. The stages of the condition are outlined below.
Early stage - attacks of vertigo are sudden and unpredictable. They are usually accompanied by nausea, vomiting and dizziness. Attacks of vertigo at this stage tend to last from 20 minutes to 24 hours. You may lose some hearing during the attack, but this returns to normal when the attack is over. Your ear may also feel blocked and uncomfortable, with a sense of fullness. There is often tinnitus at the same time.
Middle stage - attacks of vertigo continue, although the attacks become less severe. Tinnitus and hearing loss often become worse. During the middle stage you may experience some periods of remission (where symptoms go away) which can last for up to several months.
Late stage - episodes of vertigo occur far less frequently and may stop altogether. However, you may still be left with balance problems, and may find that you are unsteady, particularly in the dark. Your hearing problems may become progressively worse, and your tinnitus will also tend to worsen during this stage.
Secondary symptoms
There are a number of secondary symptoms that are associated with Ménière's disease.
Stress, anxiety and depression
As Ménière's disease is an unpredictable and sometimes difficult condition to manage, it can leave you feeling stressed, anxious and depressed. Ménière's disease can have a significant impact on your day-to-day lifestyle. For example, the condition can affect your work, and it can be particularly dangerous for those with Ménière's disease to use ladders, scaffolding and to operate machinery.
Hearing loss can make it difficult to interact with others, both in the workplace and at home. Tinnitus can also sometimes make it difficult to sleep, leaving you tired and more susceptible to stress. You may be unable to drive (see recovery section), which can limit your social contact. If you are feeling stressed or upset, your GP may be able to offer support.
^^ Back to top
Diagnosis
There is no single test for Ménière's disease. Your GP will look at your medical history, consider your symptoms and conduct a physical examination. For the condition to be diagnosed, you will need to have all three of the primary symptoms of vertigo (at least two episodes lasting 20 minutes or more within a single attack), tinnitus and hearing loss. However, you should be referred to an ear nose and throat (ENT) specialist to assess the extent of your hearing loss before a definite diagnosis of Ménière's disease can be established.
Ménière's disease can be difficult to distinguish from other diseases because there are several conditions that can also cause vertigo and hearing problems. For example, migraines and ear infections can affect balance and hearing. Ménière's disease may only become evident after a period of time, as a typical pattern of recurrent attacks develops.
Audiogram
Hearing loss caused by Ménière's disease can be examined using a test called an audiogram. This is done using a simple machine called an audiometer that produces tones of adjustable loudness and pitch. You will listen on headphones and signal when sounds are heard, or are no longer heard. To take this test, you must have normal hearing in one ear, so that the specialist can detect abnormalities through comparison. It is not always effective if you have early-stage Ménière's disease because hearing loss in this stage is often temporary.
Other tests
You may be referred for additional tests to confirm that your symptoms are not being caused by something else.
^^ Back to top
Risks
If you drive and you are diagnosed with Ménière's disease, or you are experiencing the primary symptoms of vertigo and hearing loss, then you must inform the Driver and Vehicle Licensing Agency (DVLA) of your condition. The DVLA states that if you drive a car, or motorcycle, and you have recently been diagnosed with Ménière's disease, you must cease driving. Driving will not be permitted again until you have satisfactory control of your symptoms. Your GP or ear, nose and throat specialist will have to confirm that your symptoms have improved and are under control.
If you drive a large goods vehicle, or a passenger carrying vehicle, then you will have your license either revoked or refused on diagnosis of Ménière's disease. You must be symptom free for a year before you will be able to reapply for a licence.
The DVLA will send you a questionnaire to find out how your condition affects you. They will also ask permission to contact your GP, or ENT specialist, so that they can make a more detailed assessment of your physical ability to drive.
For more information on your entitlement to drive please contact the DVLA (see 'selected links').
^^ Back to top
Treatment
There is no cure for Ménière's disease. However, your GP and ear, nose and throat (ENT) specialist will be able to help you manage your symptoms. They will offer advice and information that is tailored to your individual needs, and develop a management plan that will help you cope more effectively with your symptoms.
There are a variety of treatments for the different symptoms caused by Ménière's disease. These are outlined below.
Treatments for vertigo
Prochlorperazine
Prochlorperazine may be used on a short term basis to help ease nausea and vomiting. Prochlorperazine can make some people feel sleepy, and it may not be tolerated by everyone. If you develop a fever (high temperature) and feel unwell, seek medical advice.
Antihistamine
Alternatively, an antihistamine, such as cinnarizine, or cyclizine, can be used on a short term basis to help ease nausea and vomiting. Antihistamines all have slightly different cautions, and possible side effects, although they have the potential to make you sleepy to different degrees.
Preventing attacks of vertigo
Betahistine
Betahistine is a medicine which helps to increase blood flow around the inner ear and can help to prevent vertigo occurring. If taken for up to a year, it may reduce the number and severity of attacks of vertigo, although there is no firm evidence that it is effective.
Physiotherapy
A physiotherapist can help improve your balance by teaching you a number of different exercise techniques. These exercises help by teaching you how to cope with the abnormal and disorientating signals coming from your inner ear. They teach you how to use alternative signals from your eyes, ankles, legs and neck to keep you balanced.
Surgery
In severe cases, surgery can be performed to help reduce attacks of vertigo. Surgical procedures are usually only used as a last resort. A procedure called endolymphatic sac decompression reduces the swelling in the labyrinth by removing some of the bones surrounding your inner ear.
A labyrinthectomy involves the complete removal of the vestibular labyrinth (system of tiny, fluid filled channels in the ear, which send out signals of sound and balance to the brain). However, the procedure can only be performed if one ear is affected and the hearing loss is severe because it means you will not be able to hear from that ear again. Your other ear will take over your hearing and balance.
Treatments for tinnitus
Sound therapy
The effects of tinnitus are often more pronounced in quiet environments. Sound therapy works by reducing the difference between tinnitus sounds and background sounds in order to make the tinnitus less intrusive, and to help you to relax. A hearing therapist can advise you.
Relaxation techniques
As tinnitus can be a distressing and intrusive condition, relaxation techniques are important to help you avoid stress and anxiety. You can find more information about ways to cope with tinnitus by visiting the British Tinnitus Association website (see 'selected links').
Treatment for hearing loss
If you have middle or end stage Ménière's disease, you may experience more permanent hearing loss. Ménière's disease tends to make you more sensitive to loud sounds and also makes it harder for you to distinguish low pitched sounds. Hearing therapists and organisations such as the Royal National Institute for Deaf and Hard of Hearing People (RNID) can provide you with helpful advice for dealing with hearing loss (see 'selected links').
Treatments for stress and anxiety
Counselling
As Ménière's disease is a difficult and unpredictable condition, it can often affect your home life, work, and the way you interact with others. Counselling allows you to talk through the problems you are experiencing. During a counselling session, you can talk through your feelings and also discuss ways of improving your quality of life by learning to cope with attacks of vertigo and hearing loss.
Support groups and charities
There are several support groups and charities that will provide you with useful advice and information about living with Ménière's disease. They can also put you in touch with other people who have the condition so that you can share experiences and provide support to one another. The UK Ménière's Society offers a range of resources and information for people with Ménière's disease, and for those who care for them. The Royal National Institute for Deaf and Hard of Hearing People also has a dedicated section for Ménière's disease. (See 'selected links' for more information).
^^ Back to top
Prevention
As the precise cause of Ménière's disease is not yet fully understood, there is no known way of preventing the condition developing.
However, with the right treatment and medication, Ménière's disease can be managed effectively and your symptoms will usually improve. The individual management plan devised for you by your GP, or ENT specialist, will help you learn how to deal with your symptoms. It will also help you to cope with the feelings of stress and anxiety that can be caused by Ménière's disease.
^^ Back to top