What is Meniere’s Disease?

Meniere’s disease is a disorder affecting the inner ear that is defined by 4 symptoms: (1) vertigo; (2) ear pressure; (3) wind-noise tinnitus; and (4) fluctuating hearing loss. These symptoms usually occur at the same time with “attacks” lasting several hours and can be quite debilitating. And they can progress even with medical treatment, so regular monitoring with an audiologist and otolaryngologist is important. So how do you know whether you might be suffering from Meniere’s disease? Let’s take a closer look at the symptoms…

Vertigo

When the signals from your eyes, vestibular system (the balance organs in the ears), or your proprioception (feeling of the ground below you) don’t match with each other, you become dizzy. For example, sitting too close to the screen at a movie might make you feel like you’re moving because the information from your eyes contradicts the information from your vestibular and proprioception systems.

There are two main categories for dizziness: (1) presyncope; and (2) vertigo. Presyncope is a lightheaded sensation, like what you might get when standing too quickly or when you’re about to faint. If you have presyncope, it’s likely that you may be experiencing low blood pressure, an effect of medication, or some other problem like postural tachycardia syndrome.

By contrast, vertigo is a spinning sensation (either you or the room around you). This spinning sensation happens when the vestibular organ in one of your ears is more or less active than the one in your other ear. That difference signals a reflex that causes your eyes to move and makes you feel dizzy.

Ear Pressure

Also known as “aural fullness”, this is usually described as an underwater sensation. People report feeling like their ear is clogged or needs to pop. With Meniere’s disease, ear pressure tends to occur during episodes and dissipates shortly after.

Tinnitus

There are lots of different types of tinnitus (phantom sounds in the ear). But tinnitus you get from Meniere’s disease tends to have a certain sound quality to it. Most patients report wind, “whooshing”, waterfalls, or other broadband noises. The tinnitus tends to be worse during episodes but can remain after, especially as your hearing worsens over time. Your tinnitus may also worsen in quiet environments or stressful situations.

Tinnitus is usually a symptom of some other problem. But it can seriously affect you physically, emotionally, and socially if left untreated. Tinnitus can cause stress, anxiety, depression, and interfere with sleep and concentration. Your audiologist can help treat your tinnitus, but you may still need some medical or mental health services to help with the effects of tinnitus.

Fluctuating Hearing Loss

Patients with Meniere’s disease tend to experience fluctuations in their hearing during episodes. Some hearing loss may remain after an episode too, usually in the low pitches. As you continue to experience Meniere’s episodes, the hearing loss tends to worsen and level out around a moderate or severe sensorineural hearing loss. This is why a hearing test is such a vital component to diagnosing Meniere’s disease, and why regular follow up testing should be done to monitor its progress.

How is Meniere’s diagnosed?

Meniere’s disease is usually diagnosed with a case history and review of symptoms. There are very few diagnostic tests to identify Meniere’s disease, and their sensitivity varies. A hearing test is essential and should be repeated regularly to monitor fluctuations in your hearing. Electrocochleography (ECochG) may also help identify Meniere’s, though it’s more sensitive when you’re having an episode. Some newer imaging tests with fine resolution may also help identify Meniere’s by documenting swelling in the inner ear (called endolymphatic hydrops) that can occur with Meniere’s disease.

How is Meniere’s treated?

If you suffer from Meniere’s disease, your treatment options are unfortunately limited. Your doctor might recommend some lifestyle changes like limiting salt in your diet or managing stress. Your doctor might also prescribe some motion sickness medications to use during attacks, middle ear injections to reduce the vestibular response from the affected ear, or steroids to reduce swelling. ENThealth.org has a good synopsis of treatment options on their website.

There is no cure for Meniere’s, but it can be managed. You need to document your symptoms carefully and discuss them with your otolaryngologist to develop a plan for treatment. You should also discuss your symptoms with your audiologist and receive regular hearing evaluations in case hearing aids are necessary.

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