Ménière's disease

Overview

Ménière's disease is characterised by three main symptoms: Attacks of rotary vertigo (spinning sensation), tinnitus and hardness of hearing. This is an acute functional impairment of the inner ear that affects both balance and hearing. If dizziness persists for a longer period or recurs regularly, a doctor should be consulted.

Symptoms

Main symptoms

• Sudden attack that can last minutes or hours
• Motion sickness or rotary vertigo:
  • So severe that the patient can no longer stand and walk
  • Gait pattern can look like the weaving of a drunk person
  • Leaning to the impaired side when walking.
  • Eye tremors (nystagmus); rapid eye movements make it impossible to focus on an object and worsens the dizziness
• Tinnitus in one ear (noise in the ear)
  • In this disease, the noise is usually a low humming sound
  • In addition, feeling of pressure in or behind the affected ear
• Hearing loss: repeated or long-lasting attacks can cause a loss of hearing over time
  • More rarely, this can lead to total deafness

Other symptoms

• So-called vegetative symptoms:
  • Nausea, vomiting
  • Heart palpitations
  • Sweating attacks and sometimes headache
• Psychological consequences:
  • Insecurity
  • Anxiety disorders
  • Depression

Causes and treatment

Causes

• Immediate cause of vertigo:
  • Increased pressure in the organ of balance (through increase in lymphatic fluid)
  • Increase in lymphatic fluid is caused by an imbalance between the formation and draining of the fluid (the cause of this imbalance is not known)
• Factors that trigger an attack of Ménière's:
  • Metabolic disorders
  • Pocket of inflammation, in particular in dental roots or maxillary sinus
  • Excessive reaction by immune system
  • Various psychological factors
  • Functional disorders of the autonomic nervous system caused by stress
• Cause of hearing loss during attacks:
  • Hair cells (in the inner ear) are damaged by the potassium contained in the lymphatic fluid

Further treatment by your doctor / in hospital

Possible tests

• Neurological examination
• Wide-ranging hearing tests (audiometry) and tests of the organ of balance
• Imaging procedures
  • CT scan (computed tomography) and MRI (magnetic resonance imaging)
  • Among other things, to differentiate between Ménière's disease and other diseases of the inner skull

Possible therapies

• Medication for nausea and vomiting, tranquillisers
• Drugs to encourage blood flow (also for long-term treatment after attacks)
• If dizziness persists for a longer time and there is a noticeable hearing loss:
  • medication to switch off parts of the inner ear
• If great suffering and failure of medication to work:
  • Surgery to relieve pressure on the inner ear (main objective: elimination of vertigo attacks)
• Supportive psychological counselling or psychotherapy

What can I do myself?

• Learn strategies for coping with the hyperexcitability
• Find methods to reduce the impact of hearing loss on everyday life; hearing aid
• Regular balance training in accordance with the instructions of the doctor or therapist
• If an attack occurs:
  • lie down with the upper body elevated; bed rest.
  • Eliminate sources of noise such as the radio, record player and television
• Always have medication against nausea and dizziness (as prescribed by a doctor) with you and take them immediately when an attack starts
• Professional reorientation may be needed if you do work that can endanger yourself or others during an attack of Ménière's
  • Chauffeurs, pilots, construction workers, etc.

When to see a doctor?

• Persistent or recurring dizziness
• Acute hearing loss
• Visual disturbances, problems focusing
• Gait abnormalities

Synonyms

Ménière's disease