Ménière’s disease is thought to be caused by an abnormality within the inner ear. Researchers have found a strong link between the disease and migraines that involve the inner ear. They have also found that certain risk factors can increase the chances of somebody developing Ménière’s disease. Such risk factors include the following:
Having relatives with Ménière’s disease
Having relatives with a history of migraines, headaches or motion sickness
Having a personal history of migraines, headaches or motion sickness
Some researchers believe that Ménière’s disease is caused by an abnormal amount of fluid called endolymph in the inner ear. While doctors have found such fluid during autopsies on people known to have had Ménière’s disease, they have not yet verified that the endolymph caused the disease.
A patient with Ménière’s disease will suffer episodic attacks that can last anywhere from a few hours to a few days. The patient can experience anywhere from weeks to years of normalcy between each attack. The attacks usually occur suddenly, and they take place over a period of several years. Each attack gradually damages the inner ear and thus causes permanent balance problems and hearing loss. Symptoms of a Ménière’s attack include the following:
Temporary hearing loss
Dizziness or a spinning sensation that can be severe
Pressure or a feeling of fullness in the inner ear
Persistent roaring or ringing in the ear
The spinning sensations, more formally known as vertigo, can last anywhere from 20 minutes to 24 hours. They start and stop spontaneously. Severe vertigo can be accompanied by nausea and vomiting.
Researchers have found that both stress and salt can exacerbate vertigo. Doctors therefore recommend that a patient not eat any more than 1500 to 2000 milligrams of salt per day, and they also advise spreading salt consumption evenly throughout the day. Doctors also recommend stress management techniques like psychotherapy.
There are self-care techniques that can help a patient during an attack. For example, they should rest during and immediately after an attack; they should not try to “power through” the attack to work or do chores. In fact, the patient should avoid activities like reading or watching television that can make the attack worse. They should also avoid potentially dangerous activities like driving or operating machinery.
There is no cure for Ménière’s disease, and there are no treatments other than hearing aids for the hearing loss associated with it. Most of the treatments for Ménière’s disease are therefore aimed at reducing the frequency and severity of the vertigo attacks.
The doctor may prescribe a diuretic to reduce fluid retention, especially if they have already placed the patient on a limited-salt diet. They can recommend anti-nausea medications like promethazine to control the nausea and vomiting that can accompany vertigo. Motion sickness medications like meclizine can reduce the vertigo along with the nausea and vomiting.
If the patient has developed balance problems that persist between attacks, their doctor will send them to vestibular rehabilitation therapy to try to improve their balance.
The doctor may also recommend a Meniett device for resistant cases of vertigo. The device puts pressure on the middle ear to reduce the accumulation of fluid. The patient can use the device at home, and they typically use it three times a day for five minutes per session. The Meniett device can reduce the vertigo, feeling of fullness in the ear, and the tinnitus or ringing in the ear.
If the patient’s condition has not improved, the doctor may next try injecting medications like gentamicin or dexamethasone into the middle ear to control the vertigo. The injections are outpatient procedures, and the doctor will administer a local anesthetic beforehand.
In severe cases that have not responded to other treatments, the doctor will recommend surgery. In one procedure, the surgeon can operate on the endolymphatic sac that controls the fluid levels in the inner ear. The doctor may install a tube called a shunt to drain excess fluid.
The vestibular section is a procedure that involves cutting the vestibular nerve that connects movement and balance sensors to the brain. The procedure corrects the vertigo without compromising the patient’s hearing. The patient will need to be given general anesthesia, and they will have to spend the night in the hospital.
The labyrinthectomy involves removing that part of the inner ear that controls both balance and hearing. It is a last resort that is done only if the patient has already lost all or most of their hearing in the affected ear.