Meniere's disease

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who have Meniere's disease, or who would like information about it.

Meniere's disease is a disease of the inner ear, which causes vertigo, noises in the ear (tinnitus) and a sensation of pressure or pain in the ear. It can be a progressive disease, and can lead to hearing loss and problems with balance.

About Meniere's disease

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. Inside the inner ear are several fluid-filled tubes, called the cochlea and the labyrinth. These are the organs of hearing and balance, where sound waves are converted into nerve signals and movements of the head are detected. These signals are sent to your brain via a nerve called the auditory or eighth cranial nerve.

Meniere's disease affects the inner ear. It can occur at any age, but you are more likely to get it between the ages of 40 and 60. It usually starts in one ear, but can go on to affect both ears.

Doctors don't fully understand how hearing and balance become disrupted in Meniere's disease. It is thought fluid builds up in the tubes of the inner ear and increases the pressure inside them. This causes damage to the cells lining the tubes, which are responsible for sensing head movements and sound. The cells may recover when the pressure inside the tubes decreases again. But when these pressure changes happen often it can cause permanent damage.

Symptoms of Meniere's disease

In Meniere's disease, attacks come on suddenly and may last 20 minutes to 24 hours. You may have several attacks in a year and you may have the following symptoms.

• Vertigo - you feel as if you or things around you are moving, even when you're standing still. You may also feel nauseous or dizzy, and you may feel anxious, sweat or have a fast heartbeat. You may fall over suddenly.
• Tinnitus - this is a constant ringing or buzzing in your ears.
• Hearing loss - this can be partial or full hearing loss in the affected ear.
• A feeling of fullness (pressure) in the ear.
• Hyperacusis - sensitivity to noise.

These symptoms may be caused by problems other than Meniere's disease. If you have these symptoms, visit your GP.

As the disease progresses, vertigo can become less severe, even though the damage to your inner ear may be continuing. Hearing loss and tinnitus can get worse and may eventually become permanent. You may also start to have problems with balance.

Complications of Meniere's disease

Symptoms of Meniere's disease can be severe and unpredictable. You may need to stop doing your usual activities when you have an attack. It is common to feel down, isolated or anxious. Supportive medical care and sympathetic understanding from family, friends and colleagues will make it easier to cope.

Causes of Meniere's disease

Doctors don't fully understand why people develop Meniere's disease. However, it is thought to be caused by damage to the structures of the inner ear. This may be the result of:

• conditions affecting your immune system (eg an allergy or an autoimmune condition)
• an imbalance of the salts in the fluid of your inner ear
• certain viruses
• diseases affecting the blood vessels in your inner ear
• genetics - Meniere's disease seems to run in families

Diagnosis of Meniere's disease

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may check your blood pressure, hearing and assess your co-ordination.

Your GP may refer you to an ear specialist at your local hospital to confirm diagnosis.

Treatment of Meniere's disease

A range of treatments are available to help manage your condition. Your GP or ear specialist will discuss your treatment options with you.

Self-help

Eating a healthy balanced diet that is low in salt may help control your symptoms. Your doctor may also prescribe medicine to reduce your salt levels.

Background noise can help mask the ringing noise in your ears. This is especially useful when you are trying to sleep or work. Some examples are listed below.

• Leave a television or radio on in the background.
• Listen to recorded sounds or music to help you relax (such as bird song and wind chimes).
• Open a window to let in sounds from the outside.

Medicines

Your doctor may prescribe medicines to take when you have an attack. Some examples are listed below.

• Vestibular sedative (eg prochlorperazine or cinnarizine). This helps to control sickness and vertigo.
• Betahistine. This medicine can help reduce the severity and frequency of attacks, by reducing the build up of pressure in your ears.

If your symptoms are particularly severe, you may need to be admitted to hospital where your medicine can be given through a drip in your arm, along with any fluids and nutrients you need.

Hearing aids

If you have hearing loss, your GP may refer you to an audiologist - a health professional who specialises in helping people with hearing problems. Hearing aids can help most people with Meniere's disease. Your audiologist will discuss which one might be suitable for you.

Physiotherapy

If you have problems with balance, your GP may refer you to a physiotherapist (a health professional specialising in movement and mobility). He or she can teach you vestibular rehabilitation exercises to help improve your balance. These exercises can be particularly helpful in the later stages of the disease when problems with balance are on-going.

Talking therapies

If you are feeling down, isolated or anxious because of your condition, your GP can refer you to a counsellor, psychologist or psychotherapist. These specialists can help you with stress, anxiety or depression that you may feel as you learn to cope with your condition.

Surgery

If other treatments haven't helped manage severe vertigo, your doctor may recommend surgery. The three surgery options available are listed below.

• Decompression. This is an operation to reduce the pressure in the fluid-filled area of the inner ear.
• Vestibular nerve section. This is an operation to cut the nerve in your inner ear.
• Labyrinthectomy. This is an operation to destroy the area of your inner ear controlling balance. This operation can cause deafness and is only recommended if other treatments haven't worked.

Alternatively, the antibiotic gentamicin may be injected into your ear. This can provide the benefits of a labyrinthectomy with a lower risk of hearing loss.

These procedures are usually carried out under general anaesthetic. This means you will be asleep during the operation. These procedures are usually only recommended for one ear. If both ears were operated on you would have severe problems maintaining your balance in every day life.

Living with Meniere's disease

Symptoms of Meniere's disease can come on suddenly and be severe. It's sensible to make life-style changes to help better manage your condition. Consider the risks before starting any activities that could potentially be dangerous during a Meniere's attack.

• Always have someone with you if you go swimming, operate machinery or use ladders.
• Keep your medicines close to hand in case you need it.
• Make your home safe. Put in a stair gate and hand rails to stop you falling downstairs.
• Try to stay positive and get help for any signs of anxiety or depression early.

Contacting other people who have Meniere's disease through charities and patient groups can be a good source of support and advice. Your GP may be able to advise you about self-help groups in your area.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.