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Meniere's disease

Published by Bupa's health information team, August 2008.

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 affects your balance and hearing. It can be a progressive disease, which may eventually lead to permanent hearing loss.

About Meniere's disease
Symptoms of Meniere's disease
Causes of Meniere's disease
Diagnosis of Meniere's disease
Treatment of Meniere's disease
Living with Meniere's disease
Further information
Questions and answers
Sources

About Meniere's disease

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a number of 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.

The structures of the inner ear

It isn't fully understood exactly how hearing and balance become disrupted in Meniere's disease. However in some people with the condition, the fluid in the tubes of the inner ear seems to build up, increasing 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. However eventually, the damage can become permanent.

Meniere's disease can occur at any age, but you are more likely to get it between the ages of 30 and 60. It usually starts in one ear, but can go on to affect both ears.

Symptoms of Meniere's disease

In Meniere's disease, you tend to have attacks which come on suddenly and where you may get the following symptoms:

vertigo - this means you may feel giddy, as if you, or things around you are moving, even when you're standing still - the sensation of movement may be spinning (rotary), in a line, or a mixture; you may also be sick or feel sick
tinnitus - this is the sensation of hearing noise in your ears, such as ringing or buzzing - when the sound doesn't actually exist
hearing loss
a feeling of fullness (pressure) in the ear

You may have several clusters of attacks in a year, sometimes with months in between attacks when you don't get any symptoms. Attacks can last from several minutes to a number of hours.

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

All of the above symptoms can occur on their own or in combination in many other diseases, and are not necessarily a result of Meniere's disease. If you have any of these symptoms, you should visit your GP.

Because the symptoms of Meniere's disease can be severe and unpredictable, 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

The exact reason why you may develop Meniere's disease is not fully understood at present. However, it is thought that the disease can sometimes be triggered by the following:

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

Meniere's disease also 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 carry out some initial, basic tests, such as taking your blood pressure, checking your hearing and assessing your co-ordination.

Your GP will refer you to an ear specialist at your local hospital, such as an audiovestibular/audiological physician or ear nose and throat (ENT) surgeon, to confirm whether your symptoms are due to Meniere's disease. You will need to have hearing tests at the hospital, and may also have tests to assess your balance.

You may be diagnosed with Meniere's disease if it is confirmed that you are suffering from vertigo, in addition to at least one of the other symptoms listed above.

Treatment of Meniere's disease

A wide range of treatments are available to help with different aspects of Meniere's disease. Your GP or ear specialist will discuss your treatment options with you, and can refer you to the appropriate health professional if necessary for further treatment.

Medicines

Your GP may prescribe a type of medicine called a vestibular sedative (eg prochlorperazine or cinnarizine) to take when you have an attack. These medicines can help to control sickness and vertigo in some people. If you find these medicines helpful, you may also be given a supply to keep at home for use in future attacks.

You may also be prescribed a medicine called betahistine. This is thought to help make attacks less severe and less frequent, by reducing the build up of pressure in your ears.

Should your symptoms be particularly severe, you may need to be admitted to hospital where your medicine can be administered via 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 specialising in helping people who have problems with their hearing. Most people with Meniere's disease can be helped by the range of hearing aids available - your audiologist will discuss which one might be suitable for you.

Tinnitus devices

A number of different products are available to help with tinnitus. These produce background noise, which can help to mask the ringing noise in your ears. Examples include:

sound generators or white noise generators - these play a variety of different sounds, such as wind, rain and bird song and are left on all day to fill in any periods of silence
sound therapy CDs - these include a huge variety of sounds, such as bird song and wind chimes; music CDs can also be used

An audiologist or hearing therapist may also be able to give you support and advice on managing recurring tinnitus.

Physiotherapy

A physiotherapist (a health professional specialising in movement and mobility) may be able to help improve your balance, by teaching you special exercises called vestibular rehabilitation exercises. These exercises can be particularly helpful in the later stages of the disease.

Talking therapies

Many people find it very beneficial to see 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 to get rid of your vertigo, your doctor may advise you to have surgery. You will probably just have surgery in one ear, as surgery stops the ear from being able to control balance. If both ears were operated on you would have severe problems maintaining your balance in every day life.

Surgery for Meniere's disease includes the following.

An operation to reduce the pressure in the fluid-filled area of the inner ear (this is called decompression).
An operation to cut the nerve from your inner ear, to stop the abnormal messages causing vertigo reaching your brain (this is called a vestibular nerve section).
An operation to destroy the area of your inner ear controlling balance, completely stopping any vertigo (this is called a labyrinthectomy). This can also be done by injecting a medicine called gentamicin through your eardrum. However, a labyrinthectomy also causes complete hearing loss in that ear, so this will only be suggested if you have little hearing left in your ear, or your vertigo attacks are very severe.

These procedures are usually carried out under general anaesthetic. This means you will be asleep during the operation.

Living with Meniere's disease

Your doctor will advise you on how you can cope with your condition on a day-to-day basis. This may include:

considering the risks before starting any activities that could potentially be dangerous during a Meniere's attack, such as swimming, operating dangerous machinery or using ladders, if you get frequent, sudden attacks
keeping any medication close to hand if you get sudden attacks
moving around after an attack, as your brain will use your vision and other senses to compensate for the loss of function in your ears
trying to stay positive and getting help for any signs of anxiety or depression early

Further information

Deafness Research UK
0808 808 2222 (Helpline)
www.deafnessresearch.org.uk
Meniere's Society
0845 120 2975 (Helpline)
www.menieres.org.uk
British Tinnitus Association
0800 018 0527 (Helpline)
www.tinnitus.org.uk