All about Meniere’s disease

Estimates suggest that one in every 1,000 people in the UK have Ménière’s disease. It’s most common in those aged between 20 and 60 and affects more women than it does men. The worldwide incidence of the condition varies with estimates ranging between 3.5 per 100,000 to 513 per 100,000. Less than 3% of Ménière’s disease cases are in children.

What is Meniere’s disease?

Meniere’s disease, also known as idiopathic endolymphatic hydrops, is a disorder of the inner ear that causes vertigo, hearing loss, tinnitus and a feeling of pressure or fullness in the ear. The condition was first described by a French physician named Prosper Ménière in 1861.

There is no one exact cause of the disease but it is believed to be related to changes in the composition or volume of the fluid in the inner ear, which can affect the balance and hearing systems. Other possible contributing factors include genetic predisposition, viral infections, head trauma and autoimmune conditions.

Symptoms of Meniere’s disease vary from person to person and they might fluctuate over time. The frequency and severity of attacks also vary. There are a range of treatments to help manage the symptoms. These include changes in lifestyle or diet, medications and sometimes surgery. If Meniere’s is suspected, a GP will usually refer to an ear, nose and throat (ENT) specialist for diagnosis and treatment.

Similar conditions to Meniere’s disease include:

• Vestibular migraine – This is also called migraine-associated vertigo.
• Transient ischaemic attack (TIA) – This is also called a mild or mini-stroke and causes symptoms that usually resolve within 24 hours.
• Labyrinthitis – This is another condition of the inner ear that can cause problems with balance and vertigo. Unlike Meniere’s disease, labyrinthitis is curable.

Is Meniere’s disease curable?

Though Meniere’s disease can be treated, it’s not considered to be curable. In a lot of cases, symptoms disappear after five to fifteen years. However, people can be left with permanent poor hearing, tinnitus and poor balance.

Who is at risk of Meniere’s disease?

Though Meniere’s disease can occur at any age, it most commonly affects people who are between 40 and 60 years old. It is also more common in women than in men.

 Risk factors for developing the condition include:

1. Family history: People who have immediate family members with Meniere’s disease have an increased risk of developing it too.

2. Previous head injury: Those who have had a head injury are more likely to develop the condition.

3. Autoimmune disorders: Someone with autoimmune disorders like rheumatoid arthritis and lupus are more likely to get Meniere’s disease.

4. Migraines: If you have migraines, you’re more likely to get Meniere’s disease.

5. Allergies: People who have allergies are more likely to develop Meniere’s disease.

6. Viral infections: Sometimes Meniere’s disease is triggered by a viral infection and so anyone who gets a viral infection could develop it.

Having risk factors does not necessarily mean that someone will go on to develop Meniere’s disease.

What causes Meniere’s disease?

Though the exact cause of Meniere’s disease isn’t fully known or understood, it is thought to be related to changes in the pressure and fluid of the inner ear. It is believed to be caused by a number of factors like abnormal fluid build-up, an abnormal immune response, genetics, environmental factors and vascular problems.

Abnormal fluid build-up

Meniere’s disease can be caused by an excessive build-up of fluid in the inner ear. This leads to increased swelling and pressure that affects hearing and balance.

Abnormal immune responses

It is believed that an abnormal immune response causes inflammation and damage to the inner ear.

Genetics

There is likely a genetic component to Meniere’s disease as it tends to run in families.

Environmental factors

There are links between exposure to toxins, viral infections and head trauma that increase a person’s risk of developing Meniere’s disease.

Vascular problems

It is believed that blood flow to the inner ear is related to changes in fluid balance and so vascular problems could cause the condition to develop.

Though the exact cause of Meniere’s disease isn’t known, it’s likely to be a combination of different factors that contribute to the development of the condition. More research is certainly needed in this area.

What are the symptoms of Meniere’s disease?

Like many conditions, the symptoms associated with Meniere’s disease vary from person to person.

Possible symptoms include:

• Vertigo: This is a sensation of dizziness or spinning that can last minutes to hours. Vertigo is often accompanied by nausea, vomiting, feeling unsteady and sweating.
• Hearing loss: The disease can cause hearing loss fluctuations in one or both ears. Sometimes this hearing loss is permanent.
• Tinnitus: Tinnitus is a ringing or buzzing in the ears. It cannot be heard by anyone else and can be intermittent or continuous.
• Hypersensitivity to sounds: This is an important and common symptom, which can be measured by exposing patients to sounds to gauge their loudness discomfort levels, or LDLs.
• Fullness in the ear: People affected by Meniere’s disease might experience pressure or fullness in the affected ear.
• Headache: Some people who have Meniere’s disease experience headaches. This is more likely during or after a vertigo attack.
• Panic attacks and anxiety: Due to the unpredictable nature of Meniere’s disease, people can experience panic attacks and anxiety.
• People can also experience symptoms that are linked to autonomic nervous system reactions. This can include feelings of being pushed to the floor and drop attacks.

It’s important to note that Meniere’s disease symptoms can occur suddenly and might come and go over time. Some people will experience periods of remission between episodes while others will have severe, frequent symptoms.

The impacts of Meniere’s disease

This condition can have a significant impact on a person’s quality of life, particularly if the symptoms are severe or frequent. One impact is impaired balance. This might make it difficult to carry out everyday tasks like working, walking or driving.

Another difficulty and impact are problems with communication. Hearing loss and tinnitus makes communication difficult, particularly if there is a crowded or noisy environment. This, along with other symptoms, means people with Meniere’s disease often feel socially isolated, which leads to feelings of loneliness.

Given the range of symptoms and how distressing they are, anxiety and depression are common. Meniere’s disease is frustrating too and means that people are not able to be as productive. Their work life can be affected, particularly if their work requires them to have good balance or hearing. With balance and vertigo issues, people are more likely to have falls, especially if they are older.

In the United Kingdom, the ability to drive with Meniere’s disease can depend on how severe and frequent the symptoms are. Generally, people who have Meniere’s disease are allowed to drive provided that their symptoms are well controlled and they do not affect their ability to drive safely.

However, if a person has severe, unpredictable and frequent symptoms, they might be advised not to drive until their symptoms improve. This is because the dizziness and vertigo that comes with Meniere’s disease can impair a person’s ability to drive safely and it could put them and others at risk.

If someone who has Meniere’s disease isn’t sure about their ability to drive safely, they should discuss it with their healthcare provider and the DVLA (Driver and Vehicle Licensing Agency). It might be necessary for someone to undergo a medical examination and provide evidence that their symptoms are controlled enough to allow them to drive safely.

What triggers Meniere’s disease?

When someone has been diagnosed with Meniere’s disease, they might find their symptoms have particular triggers. Identifying triggers can be a challenge.

 Possible triggers include:

• Stress and anxiety: Emotional stress and anxiety can worsen existing symptoms or trigger symptoms of Meniere’s disease.
• Certain foods: Some people find that their symptoms are triggered by particular foods. Examples of food triggers are high-salt foods, alcohol, caffeine and MSG (monosodium glutamate).
• Air pressure changes: Travelling to high altitudes or flying can cause changes in air pressure that can trigger symptoms.
• Fatigue: Exhaustion or lack of sleep can make the symptoms of Meniere’s disease worse for some people.
• Hormonal changes: Changes in hormones, such as those that occur during menstruation or pregnancy, can trigger or worsen symptoms in some women.
• Viral infection: Some people diagnosed with Meniere’s disease report that viral infections like colds and flu can trigger or worsen Meniere’s symptoms.

It’s important for people diagnosed with Meniere’s disease to identify their individual triggers. This will allow them to take steps to avoid or manage triggers. It could be making dietary changes, managing stress, sleeping better or taking precautions not to get viral infections. Healthcare providers can help patients to develop personalised treatment plans that take into account individual triggers.

How is Meniere’s disease diagnosed?

In the United Kingdom, Meniere’s disease is typically diagnosed by an ENT or another specialist healthcare provider based on a combination of the patient’s medical history, symptoms and diagnostic tests.

Medical history

A detailed medical history will be taken to determine how long a person has been experiencing symptoms, how often they occur and whether they are accompanied by things like tinnitus and hearing loss.

Physical examination

Healthcare providers will perform physical tests to look for balance problems or hearing loss. These tests include hearing tests like audiograms to determine whether there is any hearing loss and whether or not it is consistent with Meniere’s disease. Other tests performed include balance tests like videonystamography (VNG) tests. This can help to assess vestibular function and balance. Finally, imaging tests like CT scans or MRI tests. These scans and tests can be used to rule out conditions that can cause similar symptoms like multiple sclerosis (MS) or brain tumours.

People who have suspected Meniere’s disease need to be seen by specialist healthcare providers who specialise in ear, nose and throat (ENT) conditions.

Diagnostic criteria

The criteria for diagnosing Meniere’s disease are specific. If the patient has experienced two or more vertigo episodes spontaneously and each one has lasted between 20 minutes and 12 hours, and they have hearing loss and other aural symptoms, then it is likely that they have the condition.

Though the symptoms of migraine-associated vertigo (MAV) often overlap with those of Meniere’s disease, the hearing loss with MAV is typically in both ears and doesn’t progress. With Meniere’s disease, hearing loss usually is only in one ear and progresses.

Doctors should work to exclude other possible conditions like vestibular paroxysmia, vestibular schwannoma and recurrent unilateral vestibulopathy.

How is Meniere’s disease treated?

The treatment for Meniere’s disease in the United Kingdom depends on the frequency and severity of symptoms and is personalised to each patient. The goal of any treatment is always to control symptoms and improve the quality of life.

Common treatments include:

• Medications: Diuretics, anti-nausea drugs and betahistine are often prescribed to control Meniere’s disease symptoms like nausea and vertigo.
• Lifestyle changes: Some people benefit from changes to their lifestyle, including reducing their intake of salt, avoiding alcohol and caffeine and ensuring they get enough rest.
• Vestibular rehabilitation therapy: VRT is a type of physical therapy that reduces vertigo and dizziness and helps to improve balance. This is recommended for those who have persistent Meniere’s symptoms despite lifestyle changes and medication.
• Surgery: If the symptoms are severe and don’t respond to other treatments, surgery might be considered. Common procedures include vestibular nerve section and endolymphatic sac decompression.
• Counselling: Since Meniere’s disease causes psychological distress, counselling and relaxation techniques can often be helpful to teach people skills to manage and cope with their symptoms.

Final thoughts: Meniere’s disease prognosis

Usually, Meniere’s disease is confined to one ear, but in around 30% of cases it can end up in both ears. There are also several common comorbidities associated with the condition. This includes arthritis, gastroesophageal reflux disease, psoriasis, migraine and irritable bowel syndrome (IBS).

There is support out there for those who have been diagnosed with Meniere’s disease. The Meniere’s Society is a unique UK-registered charity that supports those affected by the disease. They offer support for patients and their families.