What is Meniere’s Disease? Causes, Symptoms and Treatment Options.
Meniere’s Disease is a disorder of the inner ear that requires medical attention. Presenting early on in the form of dizziness, nausea, and imbalance issues, many people suffering from Meniere’s Disease are not aware that it can also affect their hearing.
But over time, hearing loss will, in most cases, be added to the list of their symptoms. With permanent hearing loss looming just around the corner, those diagnosed with Meniere’s Disease need to know what options they have for protecting and restoring their hearing.
Meniere’s Disease – What is it?
In 1861, the French doctor Prosper Meniere first described the condition that would later be known by his name. Meniere’s disease is a disorder resulting from an increase in fluid pressure in the inner ear which disrupts the balance and hearing systems.
The pressure build-up caused by excess fluid in the inner ear may distort and sometimes break
the delicate hair-like sensors in the semicircular canals. As the disease progresses the cells become irreparably damaged, leading to irreversible hearing loss.
Meniere’s Disease can occur in one or both ears. It typically affects adults in their thirties and above. It is not believed to be hereditary. There is no cure for this disease, but the symptoms can be managed. Some people may experience periods of remission but the disease will reoccur.
Signs And Symptoms To Look Out For
Classically, people suffering from Meniere’s Disease will experience:
- Disabling attacks of recurrent vertigo (a spinning sensation)
- Low-pitched roaring tinnitus
- Fluctuating hearing loss
- A sense of pressure or fullness in the affected ear
These vertigo attacks are frequently associated with nausea and vomiting, and a sensation that everything is spinning around them leading to a feeling of falling or imbalance. Attacks usually last between two and four hours and leave the person feeling exhausted. Some people have several attacks of Meniere’s Disease in a short period of time, while other people only have an attack every few months or years.
Early in the course of Meniere’s disease, the hearing loss experienced during an attack will often return to normal, but over months or years will become a permanent hearing loss.
How is Meniere’s Disease Diagnosed?
Diagnosis is often not easy, as the classic symptoms are not always present and other conditions can manifest in similar ways. Researchers report that there is no definitive test to confirm the diagnosis.
According to The American Academy of Otolaryngology-Head and Neck (ASOHNS) guidelines a diagnosis of definitive Meniere’s Disease is only made at autopsy.
Audiology and selective balance function tests can assist in assessing the severity of disease and the ability to compensate for the symptoms. In some cases’ it requires an MRI scan of the brain.
What Causes Meniere’s Disease?
The underlying cause of Meniere’s Disease remains unknown. Several factors are believed to be potentially involved, such as:
- Viral infections
- Allergic responses
- Vascular irregularities
- Blockage or damage to the endolymphatic structures
Meniere’s Disease and Hearing Loss
Under normal conditions, the inner ear is supposed to be filled with endolymph—a fluid that circulates, stimulating receptors that signal information to the brain about body position and movement. These receptors are found in the balance organs.
When someone has Meniere’s, there is too much endolymph within the membranous labyrinth, which causes swelling and issues with the normal balance signals that are sent to the brain. The result is vertigo and other symptoms.
Hearing is affected in people with Meniere’s for similar reasons. Endolymph in the cochlea normally becomes compressed in response to sound vibrations, triggering sensory cells that communicate signals to the brain where the actual hearing takes place. Again, a build-up of endolymph disrupts this process.
Sometimes the inner ear can completely fill with fluid, leaving no space for the fluctuation in pressure, which then leads to acute attacks. Attacks may eventually taper off or even stop altogether. But the excess fluid continues to negatively affect balance and hearing, just in a more steady, chronic way.
This is because, over time, the constant surplus of fluid can cause damage to the delicate hair cells of the inner ear that are essential for hearing. Once these hair cells are damaged or die, they cannot be replaced. The constant excess fluid can lead to changes to the normal structure of the inner ear. This can cause chronic unsteadiness, even though the acute attacks may have dissipated.
Managing Meniere’s Disease
An Audiologist, GP, and ENT medical specialist play vital roles once a diagnosis of Meniere’s Disease has been made. Prompt treatment is required to try and avoid deafness, and alleviate the disabling symptoms, such as vertigo.
If you are diagnosed with the condition, you might be given medicines (known as diuretics) to reduce the fluid in your body and take the pressure off the inner year so you have fewer attacks. During an attack, you can use medicine to stop you from vomiting or feeling nauseous, to control vertigo and to reduce anxiety.
Treatment options include:
- Medications to treat symptoms such as vertigo, nausea, fluid build-up in the inner ear.
- Hearing aids help address any hearing loss.
- Tinnitus management to assist with the roaring buzzing sound that is present either constantly or intermittently.
- Some people have surgery to cut the nerve responsible for balance, or to drain fluid from the inner ear.
Sometimes steroids or antihistamines can help. If you experience severe symptoms with Meniere’s disease or frequent attacks, your doctor may suggest referral to an ENT (Ear, Nose & Throat) Specialist.
You can help to prevent attacks by:
- Dietary changes that may decrease the amount of fluid in the inner ear, which can weaken the symptoms of the disease
- Drink less caffeine, reduce chocolate and alcohol consumption
- Reduce salt intake
- Stop smoking
- Practice stress management
- You may have to change some of your daily activities, e.g. be careful when climbing ladders, swimming or operating heavy machinery
- Consult with your doctor about driving safely
Are Cochlear Implants The Solution?
A cochlear implant is an implantable device that bypasses the outer, middle, and inner ear and stimulates the hearing nerve directly via electrical stimulation.
Cochlear implants may be a good option for those looking to restore their hearing. Typically, people suffering from Meniere’s will have significant hearing loss and can be struggling with understanding speech in everyday life, despite well-fitted hearing aids.
Studies by various authors concluded that cochlear implants did provide benefit to Meniere’s patients with severe to profound sensorineural hearing loss. The outcomes for people with Meniere’s Disease getting a cochlear implant were found to be comparable to people without the
disease who got a cochlear implant.
In a Nutshell
Meniere’s Disease is unpredictable and the hearing loss it causes fluctuates with people gradually developing permanent sensorineural hearing loss, which will progressively get worse. Continuously assessing your individual health situation is important to help you get the appropriate treatment, manage the disease, and assess your suitability for hearing aids.
If you have Meniere’s Disease and struggle to hear speech in everyday life despite wearing well-fitted hearing aids, a cochlear implant may well be an option for you. Research supports the notion that cochlear implants may result in good outcomes for people with Meniere’s Disease.
If you have Meniere’s Disease or can identify with the signs and symptoms listed in this article, we highly recommend that you speak with your GP or trusted, local Audiologist who can refer you to an ENT medical specialist for expert review.