Ménière disease

  • Definition
    • Ménière disease is an inner ear disorder that affects balance and hearing.

  • Alternative Names
    • Hydrops; Hearing loss; Endolymphatic hydrops; Dizziness - Ménière disease; Vertigo - Ménière disease; Hearing loss - Ménière disease; Dizziness - Ménière disease

  • Causes
    • Your inner ear contains fluid-filled tubes called labyrinths. These tubes, along with a nerve in your skull, help you know the position of your body and help maintain your balance.

      The exact cause of Ménière disease is unknown. It may occur when the pressure of the fluid in part of the inner ear gets too high.

      In some cases, Ménière disease may be related to:

      Other risk factors include:

      • Alcohol use
      • Allergies
      • Family history
      • Recent cold or viral illness
      • Smoking
      • Stress
      • Use of certain medicines

      Ménière disease is a fairly common disorder.

  • Symptoms
    • Attacks of Ménière disease often start without warning. They may occur daily or as rarely as once a year. The severity of each attack can vary.

      Ménière disease usually has four main symptoms:

      • Hearing loss that changes
      • Pressure in the ear
      • Ringing or roaring in the affected ear, called tinnitus
      • Vertigo, or dizziness

      Severe vertigo is the symptom that causes the most problems. With vertigo, you feel as though you are spinning or moving, or that the world is spinning around you.

      • Nausea, vomiting, and sweating often occur.
      • Symptoms get worse with sudden movement.
      • Often, you will need to lie down.
      • You may feel dizzy and off-balance for anywhere from 20 minutes to 24 hours.

      Hearing loss is often only in one ear, but it may affect both ears.

      • Hearing tends to improve between attacks, but gets worse over time.
      • Low frequency hearing is lost first.
      • You also may have roaring or ringing in the ear (tinnitus), along with a sense of pressure in your ear

      Other symptoms include:

  • Exams and Tests
    • A brain and nervous system exam may show problems with hearing, balance, or eye movement.

      A hearing test will show the hearing loss that occurs with Ménière disease. Hearing may be near normal after an attack.

      A caloric stimulation test checks your eye reflexes by warming and cooling the inner ear with water. Test results that are not in the normal range can be a sign of Ménière disease.

      These tests may also be done to check for other causes of vertigo:

  • Treatment
    • There is no known cure for Ménière disease. However, lifestyle changes and some treatments can help relieve symptoms.

      Your health care provider may suggest ways to reduce the amount of fluid in your body. This can often help control symptoms.

      • Water pills (diuretics) may help relieve fluid pressure in the inner ear
      • A low-salt diet may also help

      To help ease symptoms and stay safe:

      • Avoid sudden movements, which may worsen symptoms. You may need help walking during attacks.
      • Avoid bright lights, TV, and reading during attacks. They can make symptoms worse.
      • Do not drive, operate heavy machinery, or climb until 1 week after your symptoms disappear. A sudden dizzy spell during these activities can be dangerous.
      • Remain still and rest when you have symptoms.
      • Gradually increase your activity after attacks.

      Symptoms of Ménière disease can cause stress. Make healthy lifestyle choices to help you cope:

      • Eat a well-balanced, healthy diet. Don't overeat.
      • Exercise regularly, if possible.
      • Get enough sleep.
      • Limit caffeine and alcohol.

      Help ease stress by using relaxation techniques, such as:

      • Guided imagery
      • Meditation
      • Progressive muscle relaxation
      • Tai chi
      • Yoga

      Your provider may prescribe:

      • Antinausea medicines to relieve nausea and vomiting
      • Diazepam (Valium) or motion sickness medicines, such as meclizine (Antivert, Bonine, Dramamine) to relieve dizziness and vertigo

      You may need ear surgery if your symptoms are severe and do not respond to other treatments.

      • Surgery to cut the vestibular nerve helps control vertigo. It does not damage hearing.
      • Injecting steroids or an antibiotic called gentamicin directly into the middle ear can help control vertigo.
      • Removing part of the inner ear (labyrinthectomy) helps treat vertigo. This causes complete hearing loss.

      Hearing aids may be needed for severe hearing loss.

  • Outlook (Prognosis)
    • Ménière disease can often be controlled with treatment. Or, the condition may get better on its own. In some cases, Ménière disease can be (long-term) chronic or disabling.

  • When to Contact a Medical Professional
    • Call your provider if you have symptoms of Ménière disease, or if symptoms get worse. These include hearing loss, ringing in the ears, or dizziness.

  • Prevention
    • You can't prevent Ménière disease. Treating early symptoms right away may help prevent the condition from getting worse. Treating an ear infection and other related disorders may be helpful.

  • References
    • Chang AK, Olshaker JS. Dizziness and vertigo. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 19.

      Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 165.

      Ruckenstein MJ, ed. Ménière's Disease; Evidence and Outcomes. San Diego, CA: Plural Publishing; 2010.