Meniere’s Disease
What is Meniere’s Disease?
First described by Prosper Meniere in 1861, Meniere’s Disease is a clinical syndrome that involves spontaneous episodes of vertigo with associated hearing symptoms such as hearing fluctuations or loss, tinnitus or fullness in the ear
What are the symptoms of Meniere’s Disease?
Meniere’s attacks are characterized by:
Recurrent, spontaneous episodes of vertigo, lasting at least 20 minutes or up to 12 hours, frequently very debilitating and accompanied by imbalance, nausea and/or vomiting
Hearing loss – often fluctuating early in Meniere’s Disease
Tinnitus – in the affected ear only and either occurring with the episode or, if already present, increasing in volume or changing pitch with the episodes
Aural fullness on the affected side
There are also atypical forms of Meniere’s disease where the patient may just have hearing problems or vertigo in isolation
Recurrent episodes tend to lead to a progressive loss of audio-vestibular function. After some time sufferers often start to complain of symptoms in between episodes including:
Hearing loss – generally initially affecting low tones/frequencies
Tinnitus and/or aural fullness
Intermittent dizziness
Intermittent imbalance
How is Meniere’s Disease diagnosed?
Diagnosis can be difficult and is usually reliant on a careful history taking and physical examination. It often is useful to have tests of the ear such as audiometric examination (pure-tone sensitivity and word recognition/speech discrimination) and vestibular/balance function testing.
What causes Meniere’s Disease?
The exact cause of these episodes is unknown however it has been associated with something known as endolymphatic hydrops. Endolymphatic hydrops is an increase in the volume of the fluid in the inner ear, which puts pressure on the sensory organs in the Cochlear and the Vestibule
What is the management of Meniere’s Disease?
Management is divided into treatment of the acute vertigo attacks and management strategies of any symptoms in between attacks
TREATMENT OF THE ACUTE VERTIGO ATTACKS
Ensure safety - especially if driving or dangerous working situations
Allow attacks to pass - noting that after the severe symptoms have passed, sufferers can feel “washed out” afterwards for a day or two
Medication such as vestibular suppressants with anti-nausea effects
If severe or prolonged attack may require hospitalization for intravenous re-hydration
MANAGEMENT STRATEGIES IN BETWEEN ATTACKS
Education
Vestibular Rehabilitation exercises may be of benefit in reducing symptoms after or between episodes, and help to restore your day-to-day function
Lifestyle changes with regular diet, sleep patterns and exercise. Some sufferers report a benefit from a low salt diet (less than 2g/day) or reducing caffeine/alcohol
Medication
Semi-invasive and Surgical Treatments
Psychological Support - for some clients, the time taken to accurately diagnose and stabilize their condition, as well as the need to adjust their lifestyle to manage this disease, can lead to anxiety, depression and other mental health issues. Counselling is recommended for these people.