What is Meniere's Disease?
Meniere’s disease is a disorder of the inner ear that results in hearing and balance related symptoms. Meniere’s disease involves the development of endolymphatic hydrops.
Endolymphatic hydrops is believed to be an excess of fluid in the vestibular (balance) and cochlear (hearing) apparatus of the inner ear, causing damage to the vestibular and cochlear structures. This damage is physical with increased pressure on structures causing dysfunctional changes.
There is also chemical damage, with altered potassium levels affecting the function of the membranes. The damage progresses over time with each repeated episode of Meniere’s disease, and ultimately results in significant loss of balance and hearing in some people.
Stages of Meniere's Disease
The symptoms of Meniere’s disease change over time. Three general stages have been identified:
- Stage 1: episode of spinning or vertigo lasting hours/days.
- Stage 2: recurrent episodes of vertigo, intermittent tinnitus, aural fullness and fluctuating hearing. This is usually when diagnosis is achieved.
- Stage 3: severe hearing loss, constant tinnitus, unsteadiness, decreasing episodes of vertigo.
Diagnosis of Meniere's Disease
There are some conditions that may mimic or present similarly to Meniere’s disease and need to be ruled out. The typical tests that may need to be performed include:
- Blood tests and CT/MRI brain scan to exclude other conditions such as acoustic neuroma, stroke and vestibular migraine
- Neurological physical assessment
- Hearing tests – these may need to be performed repeatedly to detect fluctuating hearing loss associated with Meniere’s disease attacks
- Vestibular and balance tests by a physiotherapist and audiologist
Meniere’s disease is usually diagnosed around late thirties to early fifties. It is uncommon for children to be diagnosed.
Management of Meniere's Disease
Currently there is no known medical cure for Meniere’s disease. The condition can however be managed to some degree with the following:
- Education on Meniere’s disease
- Diet modification – low salt, alcohol, nicotine and caffeine
- Physiotherapy vestibular and balance exercises to help improve balance and compensation in the brain
- Manage stress and anxiety with psychology input
- Medication trial such as diuretics, vestibular suppressant (Stemetil), vestibular sedative (Valium), vasodilator (Serc)
- Last resort therapy offered by ENT specialists may include surgery, gentamicin intratympanic injection, or vestibular nerve section. These are irreversible and may cause a constant sense of imbalance even if the vertigo attacks cease.