Disorders

What is Ménière’s Disease?

In 1861, French physician Prosper Ménière described a condition that now bears his name. Ménière’s Disease (MD) is a disorder of the inner ear associated with a change in the volume of fluid inside a portion of the inner ear called the labyrinth, which includes the membranous and bony labyrinth. It causes episodes of vertigo, tinnitus (a constant noise in one ear, often described as a buzzing or humming sound), a feeling of fullness or pressure in the ear, and fluctuating, progressive low-frequency hearing loss.

The incidence of Ménière’s disease has been estimated to range from 0.5 to 7.5 per 1000, although this figure depends upon a number of factors, such as the diagnostic criteria used to define the disease. It also varies by ethnic background, showing relatively high incidence in Britain and Sweden. MD most commonly affects people in their 40s and 50s, although individuals from 20 onwards may be affected. It is rarely, though occasionally reported in children. Males and females appear to show a similar incidence of Ménière’s.

There is no clear cause for MD, and it does not appear to be a hereditary disease.

Symptoms

A typical attack of Ménière’s disease may be preceded by fullness or aching in one or both ears. Hearing fluctuation or tinnitus may also precede an attack. A Ménière’s episode generally involves:

• Severe vertigo (spinning)
• Imbalance
• Nausea and/or vomiting

The average attack lasts two to four hours. After a severe attack, most people find that they are extremely exhausted and must sleep for several hours.

In some people, Ménière’s episodes may occur in clusters; that is, several attacks may occur within a short time. In other cases, weeks, months, or even years may pass between episodes. Between the acute attacks, most people are free of symptoms or note only mild imbalance and tinnitus.

In most cases, Ménière’s disease is confined to one ear. Frequently, hearing in the affected ear(s) is progressively lost.

Diagnosis is difficult because other conditions present some of the same symptoms, so diagnostic testing is critical, including radiological studies.

Several recent studies describe women’s increasing anecdotal reports of symptom exacerbation during the perimenstruum (from ovulation through the menstrual bleed). To date, however, no studies have carefully explored women’s symptom reports to establish the relationship between menstrual cycle phases and Ménière’s disease responses.

Some sufferers report that attacks appear to be related to stress, but again no causal relationship has been established.

Treatment

There are an extremely large number of treatments presently being used to treat Ménière’s disease. (This is perhaps a reflection of the fact that no single treatment is effective in all patients.) They include:

• Dietary changes such as restricting the intake of salt, water, caffeine, chocolate or alcohol
• Medications including diuretics (drugs to reduce fluids), anti-emetics, anti-nausea, anti-vertigo and anti-anxiety drugs, steroids, and anti-histamines
• Nutritional supplements such as ginko biloba, ginger, and lipoflavinoids
• Surgical procedures which either cut the balance nerve or drain fluid from the inner ear.

Depending on the frequency of your attacks and the progression of the disease, your doctor or a neurologist will be able to advise the best course of treatment for you.

Prognosis

There is no cure for Ménière’s Disease. MD cannot be treated and made to “go away” as if you never had it. It is a progressive disease which worsens, more slowly in some and more quickly in others. Some patients experience periods of remission (absence of some or all symptoms) for no apparent reason. Some remissions may continue for many years; even decades. Other remissions are short-lived.

Although the attacks of vertigo may decline with time, the hearing loss and tinnitus generally persist.

Many people suffering from MD lead productive, near-normal lives; others face greater challenges in coping.

Further Information and Support

In 2019 Dr Aaron Camp was the recipient of Brain Foundation grant funding for research into Ménière’s Disease – click for more.

Click here for the latest Australian research papers on Ménière’s Disease.

Ménière Society – UK
www.menieres.org.uk

Vestibular Disorders Association – USA
www.vestibular.org

Reviewed by Dr Swee T. Aw, Department of Neurology, Royal Prince Alfred Hospital, Camperdown