Definition Meniere's disease is a disorder characterised by recurrent attacks of disabling vertigo, or a whirling sensation, hearing loss, and ringing in the ear. The disease has no known cause.
What is going on in the body? The inner ear has 2 separate components: the cochlea, which is a snail-shaped structure involved in hearing, and the labyrinth, made up of canals in the middle ear that control balance. Within the cochlea and labyrinth are 2 fluid-filled compartments that are separate from each other. The separation between the 2 compartments is necessary for hearing and balance. It allows the nerves to communicate with each other within that space. When fluid builds up, the pressure within the compartments causes the membranes to stretch, damaging the labyrinth and sometimes the cochlea. This affects both hearing and balance.
What are the signs and symptoms of the disease? The initial sign is a buildup of fluid pressure in the ear. As the pressure builds up, there is a sensation of the ear being plugged. There is also a decline in low-frequency hearing as well as a roaring or a ringing sound in the ear. Other symptoms include dizziness, nausea and vomiting, and abnormal eye movement.
What are the causes and risks of the disease? In most cases, the cause is not known. There is some evidence that inflammation in the ear causes poor fluid drainage. Other causes have been suggested, such as allergy, hypothyroidism, syphilis, high cholesterol, and excessive sodium and caffeine intake.
The main risk involves the gradual loss of hearing and balance. The dizziness could also become worse.
What can be done to prevent the disease? Prevention is not always possible, since there is no clear cause.
How is the disease diagnosed? Diagnosis is based on history and a hearing test looking for changes in low-frequency hearing.
What are the long-term effects of the disease? Recurrent increases in pressure can lead to gradual loss of hearing and balance.
What are the risks to others? Individuals may put others at risk if they have a dizzy spell while driving or working with machinery. However, Meniere's disease is not contagious.
What are the treatments for the disease? Treatment depends on the cause. If the problem is an allergy, avoidance of allergy triggers and medical management may be useful. For those with hypothyroidism, synthetic thyroid hormone medications are used. Individuals with high cholesterol can control their problem with diet and/or medication. In the case of syphilis, long-term penicillin therapy or other effective antibiotics is required.
For individuals whose symptoms are infrequent, chronic medications may be too much. It may be best to treat the dizzy spells and nausea with medication to relieve these symptoms as they occur. For those with more frequent attacks, daily diuretic therapy can be useful. Lowering caffeine and sodium intake may also be helpful. In addition, medication to dilate the small blood vessel can prove beneficial.
Destructive procedures are sometimes necessary for frequent, untreatable spells of dizziness. These procedures can take the form of surgery or medications. Surgery includes removal of the entire inner ear, known as a labyrinthectomy. This procedure can be helpful, particularly in individuals who have lost their hearing. In those who still have reasonable levels of hearing, the balance nerve can be cut.
Certain antibiotics that are toxic to the ear can also be used. When placed in high doses behind the eardrum, they can destroy portions of the inner ear. A decision must be made between deafness and a certain amount of permanent imbalance with dizzy spells.
What are the side effects of the treatments? Side effects are specific to the type of medication used. Medical or surgical destruction of inner ear structures result in a certain degree of low-level permanent imbalance and possibly deafness.
What happens after treatment for the disease? For those with frequent attacks, an appropriate diet combined with diuretics and blood vessel dilators can help reduce the frequency and severity of the attacks. Those whose inner ear structures have been removed generally become permanently deaf and have chronic imbalance.
How is the disease monitored? The disease is monitored by the frequency of the attacks and whether or not permanent injuries are beginning, such as hearing loss. If attacks are severe enough to affect the person's function and safety, medical management is necessary.
Author: Mark Loury, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
