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Meniere’s disease Causes, Symptoms and Treatment

The Meniere’s disease (or Meniere’s syndrome) is characterized by recurrent attacks of vertigo that are accompanied by hissing and ringing in the ears (tinnitus) and a hearing impairment . Most often, only one ear is affected.

This is a chronic disease . The frequency of seizures is highly variable and unpredictable. Most sufferers have some seizures a year, but some have several a week. Between crises, periods of remission can last several months or even years. There is no cure for Meniere’s disease, but the symptoms can be effectively relieved in most cases.

The Meniere’s disease was described for the first time in 1861 by a French physician, Dr. Dr. Prosper Meniere, who gave it its name.

Prevalence

Meniere’s disease most often appears at age 40 to age 60 , although cases have been described in children. She touches slightly more women than men. In Europe and North America, prevalence varies from 1 in 1,000 to 1 in 10,000, according to studies.

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Causes of Meniere’s disease

The cause of Meniere’s disease remains unknown. It is a disease affecting the inner ear, which is the deepest part of the ear that provides hearing and balance. The organ of hearing, which has the shape of a snail, is called the cochlea (or snail). The organ of balance is called the vestibule. The cochlea and the vestibule are filled with a liquid, the endolymph.

The symptoms of Meniere’s disease would be caused by an excess of endolymph in the inner ear, referred to as the endolymphatic hydrops . The excess endolymph increases the pressure in the inner ear, which prevents the sounds from being correctly perceived and blurs the balance signals sent to the brain. Thus, during a vertigo attack , contradictory information reaches the brain, as if the body were both stopped and moving.

Scientists do not know what causes pressure increase in the inner ear . Several hypotheses have been put forward:
– reaction to a head injury or certain infections;
– food allergy or intolerance;
– disruption of the immune system ( autoimmune mechanism ).

For the moment, none of these hypotheses has been formally validated.

Evolution of the disease

The disease is manifested by unpredictable crises , the frequency of which varies. During the first years of the disease, vertigo attacks tend to intensify. Then, with time (from 5 years to 10 years), they are more rare and their intensity gradually decreases.

At first, only one ear is usually affected, but nearly half of people have symptoms in both ears after a few years.

Symptoms of Meniere’s disease

The unpredictability of symptoms can cause a lot of apprehension and anxiety. Daily activities, such as driving, can become risky. In addition, even when seizures disappear, complications may persist. Some people suffer from permanent and irreversible hearing loss or balance disorders. Indeed, during repeated seizures, nerve cells responsible for the balance can die and they are not replaced. The same goes for the cells responsible for hearing.

Often, at the beginning of the disease, a series of crises occurs over a short period, ranging from a few weeks to a few months. The seizures can then disappear for several months or be spaced.

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Symptoms of a crisis

In general, the symptoms last from 20 minutes to 24 hours and lead to a great physical exhaustion.

  • A feeling of fullness in the ear and intense tinnitus (whistling, buzzing), which often occurs first.
  • An intense and sudden vertigo , which forces to lie down. One can have the impression that everything revolves around oneself, or that one turns oneself.
  • A partial and fluctuating loss of hearing .
  • Dizziness and loss of balance.
  • Quick movements of the eyes, not controllable (the nystagmus, in medical language).
  • Sometimes nausea, vomiting and sweating.
  • Sometimes, stomachaches and diarrhea.
  • In some cases, the patient feels “pushed” and falls sharply. We then speak of Tumarkin crises or otolithic crises. These falls are dangerous because of the risk of injury.

Precursory signs

The vertigo attacks are sometimes preceded by some signs , but they usually occur abruptly.

  • A clogged ear sensation, as occurs at high altitude.
  • A partial loss of hearing with or without tinnitus.
  • A headache.
  • Sensitivity to sounds.
  • Dizziness
  • A loss of balance.

Between crises

  • In some people, tinnitus and balance problems persist.
  • At first, the hearing usually becomes normal between crises. But very often a permanent (partial or total) hearing loss sets in with the years.

People at risk for Meniere’s disease

  • People with a family member who has Meniere’s disease. There is indeed a genetic predisposition to the disease. Some studies indicate that up to 20% of members of the same family may have the disease.
  • People in Northern Europe and their descendants are more prone to Meniere’s disease than people of African descent.
  • The women , who are up to 3 times more affected than men.

Risk factors

There are no known risk factors for this disease, but it seems that the following may  trigger dizziness  in people with the disease.

  • A period of high emotional stress.
  • A great fatigue.
  • Changes in barometric pressure (mountain, plane, etc.).
  • Ingesting certain foods, such as those that are very salty or that contain caffeine.

Prevention of Meniere’s disease

Can we prevent?
Since we do not know the cause of Meniere’s disease, we currently have no way of preventing it.

 

Measures to reduce the intensity and number of crises
pharmaceuticals

Some medications prescribed by the doctor can reduce the pressure in the inner ear. These include diuretic medications, which result in increased fluid elimination through the urine. Furosemide, amiloride and hydrochlorothiazide (Diazide) are examples. It seems that the combination of diuretic drugs and a low-salt diet (see below) is often effective in reducing vertigo. It would, however, have less effect on hearing loss and tinnitus.

Vasodilator medications , which have the effect of increasing the opening of blood vessels, are sometimes useful, such as betahistine (Serc in Canada, Lectil in France). Betahistine is widely used in people with Meniere’s disease because it acts specifically on the cochlea and is effective against vertigo.

Note. People on diuretic therapy lose water and minerals, such as potassium. At Mayo Clinic, it is recommended that you make sure you include high-potassium foods such as cantaloupe, orange juice and bananas as good sources. See the Potassium sheet for more information.

Food

Very few clinical studies have measured the effectiveness of the following measures in preventing and reducing seizures. However, according to the testimony of doctors and people with the disease, they seem to be of great help to many.

  • Adopting a diet low in salt (sodium): foods and drinks high in salt can vary the pressure in the ears, since they contribute to the retention of water. It is suggested that a daily intake of 1,000 mg to 2,000 mg of salt be targeted. To achieve this, do not add salt to the table and avoid prepared meals (soups, sauces, etc.).
  • Avoid eating foods that contain monosodium glutamate (MSG), another source of salt. Prepackaged foods and some foods from Chinese cuisine are more likely to contain them. Read the labels well.
  • Avoid caffeine , which is found in chocolate, coffee, tea and some soft drinks. The stimulating effect of caffeine can aggravate symptoms, especially tinnitus.
  • Also limit the consumption of sugar . According to some sources, a diet rich in sugar has an impact on the fluids of the inner ear.
  • Eating and drinking regularly helps regulate bodily fluids. At the Mayo Clinic, it is recommended that you eat about the same amount of food at each meal. Same thing for snacks.

Way of life

  • Attempt to reduce stress as it is a trigger for seizures. Emotional stress would increase the risk of crisis in the hours that follow 8 . Read our story Stress and anxiety.
  • In case of allergies, avoid allergens or treat with antihistamines ; allergies may worsen the symptoms. Some studies have shown that immunotherapy can reduce the intensity and frequency of seizures by 60% in people with Meniere’s disease who have allergies. See our Allergies page.
  • No smoking.
  • Keep important lighting during the day, and light at night to facilitate visual cues to prevent falls.
  • Avoid taking aspirin unless advised by the doctor, as aspirin can trigger tinnitus. Seek advice also before taking anti-inflammatories.

 

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Medical treatments for Meniere’s disease

There is no cure for Meniere’s disease. Some medications, however, help relieve symptoms during seizures. In addition, certain treatments allow to space the crises.

Anxiety is often important in case of Meniere’s disease. It is linked to the fear of crises, which are unpredictable and often brutal. In addition, tinnitus and persistent balance disorders are very painful and significantly degrade the quality of life. For many sufferers, it is important to find support from other patients, associations or a psychologist. See the Support Groups section. Relaxation and stress management techniques can also be beneficial.

 

Medication treatments

Drugs in case of crisis

During a seizure, medications for nausea (domperidone, dimenhydrinate: Gravol) or for vertigo(meclizine: Bonamine, Antivert) may provide temporary relief. They are taken in the form of tablets, or suppositories if the crisis is too important. Of drugs against anxiety (benzodiazepines such as lorazepam, diazepam) or against nausea (prochlorperazine, promethazine, Phenergan) can also soothe the symptoms of crisis.

Background treatment

The basic treatment aims to reduce the frequency of vertigo attacks. It is not systematic and its effectiveness is variable. Unfortunately, no treatment has been effective in all people.

The diuretic and vasodilator drugs obtained by prescription, can be beneficial. See the Prevention section.

The doctor sometimes injects medicine into the affected inner ear, through the eardrum. It may be an antibiotic , usually gentamicin. This product destroys the tissues of the inner ear. Thus, the brain no longer receives contradictory equilibrium signals, the very ones that cause vertigo. Several injections are sometimes required, depending on the response to treatment. There may be an initial period of imbalance. Due to the toxicity of the antibiotic, the risk of deterioration of hearing in the treated ear is approximately 20%. This irreversible treatment is reserved for people who have very debilitating symptoms.

Of corticosteroids such as dexamethasone, can also be injected to try to space the crisis or reduce dizziness and tinnitus resistant to other treatments. Unlike gentamicin, they are not toxic to cells.
In some cases, corticosteroids are also used during seizures, orally or intramuscularly (injections).

A device called low pressure pulse generator (Meniett) can be effective in some people. It is a device that is affixed to the input of the ear and that emits pulses at low frequency. These pulses would facilitate the evacuation of the fluid present in excess in the inner ear. Most often, 3 sessions of 5 minutes a day are prescribed to control refractory vertigo. This device is relatively effective and has the advantage of not being invasive.

Rehabilitation exercises

If vertigo persists between seizures, it may be helpful to have vestibular rehab sessions with a physiotherapist or occupational therapist. These sessions compensate for the malfunctioning of the inner ear and the vestibule (which controls the balance) through various exercises (with a rotating chair, special glasses, etc.). The physiotherapist can teach home-based exercises that will help you learn to keep your balance. Exercises consist mainly of movements of the head and body to correct the feeling of loss of balance. They train the brain to use different visual and proprioceptive landmarks to maintain balance and gait.

Hearing aids

When hearing loss is important, hearing aids can help you hear well. They are sometimes difficult to adapt because hearing loss is often fluctuating in people with Meniere’s disease. Consult a hearing care professional.

 

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Surgical treatments

When other treatments do not work and the disease is very debilitating, surgery may be offered. Surgery is usually reserved for refractory and severe cases, as it can result in loss of hearing in the treated ear.

Decompression of the endolymphatic sac . Under general anesthesia, the bone layer surrounding the endolymphatic sac, the part of the inner ear that contains the fluids (the endolymph), is removed to allow the evacuation of excess fluid. This surgical procedure is performed at the back of the ear. In about 1 in 2 people, it reduces dizziness by at least half in the short term. Longer term results are much worse. However, the procedure has a slight risk of hearing loss, in addition to the usual complications associated with general anesthesia.

Section of the vestibular nerve . During this operation, the vestibular nerve, which serves to send signals relating to the balance of the inner ear to the brain, is sectioned. Thus, it no longer sends uninterpretable signals to the brain. This operation, effective in eliminating vertigo, however, exposes the patient to permanent hearing loss. It is therefore rarely used and is reserved for extreme cases. It is also called vestibular neurotomy .

Labyrinthectomy . This intervention consists in completely destroying the sensory components of the inner ear (the labyrinth). It is the most effective for treating vertigo, but causes complete and irreversible loss of hearing . Labyrinthectomy is sometimes considered in cases where antibiotic injections have proved ineffective, or when auditory functions are already very weak and tinnitus and vertigo are very painful.

Tips during a crisis

  • Sit or relax.
  • Fix the gaze on an object.
  • Move your head as little as possible, as even small movements accentuate the symptoms.
  • Avoid bright light.
  • Do not ingest anything until nausea persists.
  • Privilege silence. The sounds of television and radio become irritating.
  • Do not read until symptoms persist.
  • Stay calm and rest as long as symptoms are present.
  • Once the crisis is over, note the symptoms to better describe them to your doctor.

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