Ménière’s Disease

Ménière’s disease is a disorder of the inner ear that can eventually cause hearing loss and vertigo. It is most common in patients who are between 20 and 50 years old.

• Ménière’s disease typically affects only one ear
• About 15 percent of patients develop symptoms in both ears

Ménière’s disease traditionally had been thought to be caused by an abnormality within the inner ear. Research by Dr. Djalilian and his team at UC Irvine has found a strong link between the disease and migraine 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 clinicians believe that Ménière’s disease is caused by an abnormal amount of fluid called endolymph in the inner ear. However, we have found that the fluid accumulation is more likely a result of the damage to the inner ear rather than the cause of the symptoms.

A patient with Ménière’s disease will suffer episodic attacks that can last anywhere from a minute to a 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 can gradually damage 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.

Previously, researchers believed that too much 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. However, our research and extensive experience has shown that sodium intake is not a critical factor as long as patients drink lots of water (8 glasses of 8 oz water per day). The primary trigger is related to the tyramine and glutamate (and other molecules) that are often present in high sodium foods (e.g., chips contains MSG and MSG contains glutamate which is a migraine trigger).

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.

Ménière’s disease can be controlled by using the migraine lifestyle and dietary changes as well as migraine medications. In a recent study, we had 92% of patients have near resolution of symptoms with the migraine regimen and medications.

If medication is not controlling symptoms, we consider injecting dexamethasone into the middle ear. We generally do not do gentamicin injections as it is destructive to the inner ear. The injections are performed in the office every 2 weeks until there is control of symptoms.

It is extremely rare that we have patients who do not respond and we have to do surgery. This occurs less than 1% of the time given how well our medical therapy works in combination with lifestyle/dietary changes intended to treat the underlying migraine that is the cause of the Meniere’s symptoms.