Meniere's Disease

What is Meniere's Disease
Meniere's disease is a disorder of the inner ear characterized by abnormal sensation of movement (vertigo), loss of hearing in one or both ears, and noises or ringing.

Causes and risks
The fluid-filled semicircular canals (labyrinth) of the inner ear, along with the 8th cranial nerve, control balance and position sense. Meniere’s disease involves a swelling of the part of the canal (endolymphatic sac) that controls the filtration and excretion of the fluid of the semicircular canal.

The exact cause of Meniere’s disease is unknown. It may be related to middle ear infection (otitis media), syphilis, or head injury. Other risk factors include recent viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs including aspirin, and a history of allergies, smoking, and alcohol use.

Prevention
Prompt treatment of ear infection and other related disorders may help prevent Meniere’s.

Symptoms

• Abnormal sensation of movement of self or the environment (vertigo): May be episodic, Lasting from minutes to more than 8 hours, Worse with sudden movement
• Dizziness
• Hearing loss in one ear: Low frequency noises lost first, Extent of hearing loss may change
• Noises or ringing in one ear (tinnitus)
• Nausea, vomiting
• Sweating, may be profuse
• Eye movements, uncontrollable

Signs and tests
A neurologic examination may show an abnormality of cranial nerve VIII. Tests to distinguish Meniere’s disease from other causes of vertigo may include:

• Head CT scan or head MRI scan Caloric stimulation (tests reflexes of the eyes) -- abnormal results indicate
• Meniere’s disease EEG, evoked potential studies
• Electronystagmography Audiology/audiometry

Treatment
There is no known cure for Meniere’s disease. Treatment is focused on relieving symptoms by lowering the pressure within the endolymphatic sac.

Antihistamines, anticholinergics, sedative-hypnotics, anti-emetics, diazepam, and other medications may relieve dizziness, vertigo, and associated nausea and vomiting. Diuretics may lower endolymphatic pressure.

Diet recommendations include a low-salt diet to reduce fluid retention (see sodium in diet). Surgery on the labyrinth, endolymphatic sac, or the vestibular nerve may be required if symptoms are severe and do not respond to other treatment. Avoid sudden movements that may aggravate symptoms.

Help may be needed with walking due to loss of balance. Rest during severe episodes, and gradually increase activity. Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until one week after symptoms disappear. During episodes, avoid bright lights, TV, or reading, which may make symptoms worse.

Prognosis
The outcome varies. Meniere’s disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

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