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Ménière’s disease

What is Ménière’s disease?

Ménière’s disease is a disorder of the inner ear that can affect your hearing and balance. The disease process is not fully understood. 

It is an unpredictable, progressive, but ultimately self-limiting condition. 

Affected persons develop excess fluid in the balance and hearing organ of the inner ear (known as ‘endolymphatic hydrops’). As this built-up happens suddenly, patients get sudden attacks of vertigo and hearing loss which settles over hours.   

It is thought that recurrent fluid build-up ultimately leads to damage of the inner ear, leading to permanent hearing loss in the affected ear.

The condition can run in families.

Ménière’s disease affects about two out of 1000 people, and it tends to occur more often in women than in men. It can develop at any age, but is more common in those aged 40 to 60.

Symptoms often include a combination of:

  • 1.

    bouts of vertigo (spinning/swaying sensation associated with nausea)

  • 2.

    hearing loss

  • 3.

    tinnitus (ringing in the ear) and

  • 4.

    a feeling of fullness in the ear. 

In about 75% of patients one ear is affected. Over a life time both ears can be affected in up to 25% of patients. The intensity of symptoms may vary, from mildly annoying to chronically disabling. Some people are unable to drive, work or take care of themselves. Others only experience occasional vertigo. 

Ménière’s disease and hearing loss

The loss of hearing (commonly in the lower frequencies) can fluctuate. It may be reversible at first, but if the hair cells in the cochlea (inner ear) become damaged, permanent hearing loss can result. The hearing loss is rarely profound. Some people benefit from hearing aids and sometimes cochlear implants. 

Dizziness

Attacks of vertigo happen suddenly, often after a short episode of tinnitus or muffled hearing. They can last between 20 minutes and 12 hours. There may be long intervals between bouts, or they may come in clusters over a few days. In some people, the vertigo can result in falls. 

vertigo

Tests and diagnosis

There is no definitive test for Ménière’s disease. To reach a diagnosis, family doctors take a full medical history and arrange an audiogram, best taken within 24 hours of an attack. They may refer patients to the ear, nose and throat (ENT) specialist or audiology department of their local hospital.

 

Treatment

Maintenance (to stop you from having bouts):

  • Salt-reduced diets; avoiding chocolates, alcohol, tobacco and caffeine. Yoga, meditation and other relaxation techniques can reduce stress. Many remedies have been described. Often it is not clear how they work or if they work for everyone.
  • Medicines include diuretics (reducing fluid), betahistine (Serc, Vergo).

Acute attack: Prednisone, urea and a short course of anti-nausea medication will help.

Surgery (rarely considered): This can be divided into hearing preservation and hearing destructive surgery. In general, the choice depends on how much hearing the patient is still left with.

 

Outlook

The disease can extend to involve both ears over time. As the vertigo attacks settle, the hearing becomes more stable. Rarely the hearing worsens to profound levels. Between 60% and 80% of sufferers are not permanently affected, and recover with or without medical help. 

Useful links

For more information and help, visit NZ Health Pages.  

There is no society for this condition in New Zealand. To find an ear, nose and throat surgeon, visit the NZSOHNS website