Meniere’s disease

DEFINITION

Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo — a sensation of a spinning motion — along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In many cases, Meniere’s disease affects only one ear.

People in their 40s and 50s are more likely than people in other age groups to develop Meniere’s disease, but it can occur in anyone, even children.

Although Meniere’s disease is considered a chronic condition, various treatment strategies can help relieve symptoms and minimize the disease’s long-term impact on your life.

CAUSES

The cause of Meniere’s disease isn’t well understood. It appears to be the result of the abnormal volume or composition of fluid in the inner ear.

The inner ear is a cluster of connected passages and cavities called a labyrinth. The outside of the inner ear is made of bone (bony labyrinth). Inside is a soft structure of membrane (membranous labyrinth) that’s a slightly smaller, similarly shaped version of the bony labyrinth. The membranous labyrinth contains a fluid (endolymph) and is lined with hair-like sensors that respond to movement of the fluid.

In order for all of the sensors in the inner ear to function properly, the fluid needs to retain a certain volume, pressure and chemical composition. Factors that alter the properties of inner ear fluid may help cause Meniere’s disease. Scientists have proposed a number of potential causes or triggers, including:

• Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
• Abnormal immune response
• Allergies
• Viral infection
• Genetic predisposition
• Head trauma
• Migraines

Because no single cause has been identified, it’s likely that Meniere’s disease is caused by a combination of factors.

SYMPTOMS

The primary signs and symptoms of Meniere’s disease are:

• Recurring episodes of vertigo. Vertigo is similar to the sensation you experience if you spin around quickly several times and suddenly stop. You feel as if the room is still spinning, and you lose your balance. Episodes of vertigo occur without warning and usually last 20 minutes to two hours or more, up to 24 hours. Severe vertigo can cause nausea and vomiting.
• Hearing loss. Hearing loss in Meniere’s disease may fluctuate, particularly early in the course of the disease. Eventually, most people experience some degree of permanent hearing loss.
• Ringing in the ear (tinnitus). Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear.
• Feeling of fullness in the ear. People with Meniere’s disease often feel aural fullness or increased pressure in the ear.

A typical episode might start with a feeling of fullness in your ear, increasing tinnitus and decreasing hearing followed by severe vertigo, often accompanied by nausea and vomiting. Such an episode might last 20 minutes to four hours, after which signs and symptoms improve. Episodes often occur in clusters, with long periods of mild or no symptoms (remission) between.

Still, the severity, frequency and duration of each of these sensory perception problems vary, especially early in the disease. For example, you could have frequent episodes with severe vertigo and only mild disturbances in other sensations. Or you may experience mild vertigo and hearing loss infrequently but have frequent tinnitus that disturbs your sleep.

When to see a doctor

See your doctor if you experience any signs or symptoms of Meniere’s disease. Because any one of these problems may be the result of other illnesses, it’s important to get an accurate diagnosis as soon as possible.

Vertigo is an uncommon but possible sign of other disorders, such as stroke, brain tumor, multiple sclerosis, or diseases of your heart or blood vessels (cardiovascular disease). See your primary care doctor immediately if vertigo is accompanied by any of the following signs or symptoms:

• Headache that is unusual or severe for you
• Double vision or loss of vision
• Speech impairment
• Leg or arm weakness
• Loss of consciousness
• Falling or difficulty walking
• Numbness or tingling
• Chest pain