Ménière Disease

Meniere's Disease Overview

Ménière disease is a syndrome in which you experience episodes of spinningvertigo (sense of the room spinning), hearing loss, and tinnitus (ringing in the ear). Between the unpredictable attacks, you usually do not have any problems or symptoms of the disease.

Ménière disease was first described in 1861 by the French physician Prosper Ménière. Yet the cause of this syndrome still remains largely unknown.

The diagnosis of the disease is usually based on a careful history and physical examination by a doctor, but other tests may be needed for a definitive diagnosis and to plan treatment options.

Ménière disease affects people of all ages, especially those of middle age or older. It is, however, uncommon in children.

 

Meniere's Disease Causes

The most common causes of the disease are still unknown. It is suspected that food allergymay play a part. Some suspect that Ménière disease is the response of the inner ear toinjury. In any case, if someone in your family has it, you are at higher risk for developing it.

 

Meniere's Disease Symptoms

Warning symptoms such as fullness or pressure in one ear may come before an acuteepisode of the disease, or attacks may occur spontaneously.

  • Common symptoms are these: 

    • Fluctuating hearing loss with distortion of sounds and difficulty with speech discrimination 
    • Ringing in the affected ear (tinnitus) 
    • A sense of the room spinning (vertigo) 
    • A cold sweat, nausea, and vomiting, or generalized weakness during the attack
  • The episodes are unpredictable and usually last from 1 hour to a few hours, depending on the severity of the disease. 
  • Recurrence of the attacks is a cardinal feature of Ménière disease. Typically the attacks are few, but the usual pattern of Ménière disease is increasing frequency and severity of the symptoms. The disease can be very disabling as the frequency and severity of the attacks increases. 
  • Early in the disease, the symptoms usually go away in several hours, but hearing loss may take a day or more to return to normal. Hearing loss can become permanent and, due to changes in the middle ear, may lead to intolerance of any loud noises.

 

When to Seek Medical Care

Call your doctor and discuss your symptoms if any of the following occur.

  • Your attack lasts for more than 3 hours. 
  • The symptoms during the attack become more severe. 
  • You pass out. 
  • You suffer hearing loss for more than 24 hours. 
  • The attack is different than your typical (previous) episodes or does not respond to home treatments including prescribed medications.

If your doctor is not available, or if the doctor recommends treatment and workup, you should go to the hospital's emergency department for further evaluation to rule out other potential causes of the symptoms or to try other treatment options.

 

Exams and Tests

The diagnosis of Ménière disease is made based on a careful history and physical exam. If the workup findings are normal and the classic symptoms continue, the diagnosis of Ménière disease is made.

  • Other potentially treatable disease processes and causes for the symptoms, however, must be ruled out. 
  • Typically, your doctor will perform a series of basic lab tests, a hearing test, and anMRI (brain scan) to rule out other causes for the symptoms.

 

Meniere's Disease Treatment

Self-Care at Home

The best way to manage an attack at home is to minimize the symptoms.

  • Lie in a quiet room with your eyes closed. 
  • Try medications prescribed by your doctor: Medications that help decrease anxietysuch as diazepam (Valium) orprochlorperazine (Compazine) can be used to help shorten and decrease the severity of the symptoms. Your doctor can prescribe these types of medications and others after a complete evaluation and treatment plan is made. 
  • If these treatments do not help during an attack, seek further medical evaluation for other treatment options. Rule out any other potential diseases.

 

Medical Treatment

The decision to manage Ménière disease medically or surgically should be made with your doctor in order to get the best results from treatment options available.

  • Most acute attacks are managed conservatively at home, or with medications prescribed by your doctor such as diazepam (Valium), which decreases anxiety, and meclizine (Antivert), which decreases the spinning sensation. Other medications are available but typically require evaluation by an ear, nose, andthroat specialist for use. 
  • Long-term management of Ménière disease is aimed at reducing the frequency and severity of the spells. A diet low in salt may help. So medications that decrease thesodium load (diuretics) may be prescribed by your doctor.

 

Surgery

Most people respond to medical management, but a few may need surgical treatment by a specialist to correct potential problems in the inner ear.

 

Next Steps

Prevention

No measures will prevent Ménière disease, but you can take preventive measures to avoid or minimize attacks and consequences of attacks.

  • Reduce salt in your diet. 
  • Stop smoking. 
  • Avoid exposure to loud noises. 
  • Manage stress
  • Use caution at home and on the job to avoid falling or having an accident if you feel dizzy.

 

Outlook

Most people can manage their symptoms with diet and lifestyle modifications and a medical plan prescribed by their doctor.

  • With a thorough evaluation and if you are motivated, you can often control attacks. Careful follow-ups with your primary caredoctor and any consultants are needed on a regular basis to monitor symptoms, progress, and adjust therapy throughout the disease process. 
  • About 10% of people require a surgical procedure to control their attacks. Thorough evaluation by an ear, nose, and throat specialist would be done for surgical options if medical management fails

 

 

Support Groups and Counseling

The psychological aspect of the disease can be devastating as well. Many people live in constant fear of violent attacks of disabling vertigo. Some require counseling, and a few may require psychiatric evaluation and medications to cope with their disease.

Synonyms and Keywords

Meniere's disease, Menieres disease, tinnitus, ringing in the ear, vertigo, spinning, dizziness, hearing loss

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