Ménière’s disease is a chronic inner ear disorder that produces a recurring set of symptoms (severe spinning vertigo, hearing loss, and tinnitus) as a result of a build-up of fluid pressure within the inner ear.
Although a Ménière’s attack may be spontaneous, some people with Ménière’s disease find that there are specific trigger substances or situations that provoke attacks. Triggers can include stress, overwork, fatigue, emotional distress, additional illnesses, pressure changes, and a diet high in carbohydrates (sugars) or salt.
Oncoming attacks may be preceded by an “aura,” a certain set of warning symptoms that may include any combination of the following:
A change in tinnitus (ringing/buzzing)
Pressure or pain in the ear
Sensitivity to sound
Muffling of sound
Sense of uneasiness or headache.
A surprising number of Ménière’s cases do not experience typical symptoms but may have spells of spontaneous, violent vertigo; fluctuating hearing loss; and ear fullness and/or tinnitus.
Late stage Ménière’s disease refers to a set of symptoms rather than a point in time. Hearing loss is more significant and is less likely to fluctuate. Tinnitus and/or aural fullness may be stronger and more constant. Attacks of vertigo may be replaced by more constant struggles with balance.
Hearing loss can occur preferentially in low and high frequencies, or across all frequencies. Most often, hearing loss occurs in the high tone (pitch) range. Permanent damage to inner ear structures can cause not only hearing loss but also problems with balance.
Conservative long-term treatment for Ménière’s disease involves adhering to a reduced-sodium diet and using diuretic medications to help eliminate water retention. The goal of this treatment is to reduce inner ear fluid pressure indirectly by lowering the pressure and osmolarity (amount of particles that hold fluid within blood vessels) of the blood. With proper care, most patients experience very few attacks and are able to function normally.
A specific attack is usually treated with an anti-emetic to lessen nausea and vomiting, and a vestibular suppressant (Valium/diazem or meclizine/antivert). Patients who do not respond to medication and diet may undergo a chemical labyrinthectomy (aminoglycoside ablation). As part of this procedure, an aminoglycoside antibiotic is injected into the middle ear, selectively diminishing vestibular signals from that ear. A few patients require surgical treatment, which can include an endolymphatic shunt or vestibular neurectomy, in which the nerve that carries inner ear balance information is severed.
Balance therapy can also help patients learn how to compensate for loss of vestibular function by retraining the way the body and brain process balance information.
For more information about treating Ménière’s disease, please contact our Balance Clinic at (727) 461-8635.