Meniere's Disease 

Introduction
Meniere’s disease is a condition that results from excess fluid in the inner ear.  The extra fluid prevents the nerves and structures that are responsible for hearing and balance from working properly.  As a result, people may experience distressing symptoms including hearing loss, dizziness, or hear unusual sounds in their ear.  Meniere’s disease can affect balance and the ability to walk.  Fortunately, there are several treatment options to help manage symptoms.

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Anatomy
The ear is divided into three areas: the outer, middle, and inner ear.  Your ear not only enables you to hear, but it plays a role in balance as well.  Structures in the inner ear work with nerves to process sounds and body position.

The labyrinth is the inner ear structure that plays a role in hearing and balance.  Part of the labyrinth is filled with a fluid called endolymph.  Continual fluid production and reabsorption maintains the level of endolymph at all times.  When you move your head, the fluid moves in the labyrinth.  The fluid movement triggers a signal to your brain that lets you know that your body has changed position.  This all happens automatically.

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Causes
Meniere’s disease results when there is too much fluid in the labyrinth.  The exact reason for the excess fluid is unknown.  The excess fluid stretches membranes in the inner ear and can cause them to rupture.  Sodium and potassium, fluids that are usually separated by the membranes, mix and cause inaccurate messages to be sent to the brain.  The inaccurate nerve signals contribute to the symptoms of Meniere’s disease.

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Symptoms
Meniere’s disease may cause several symptoms.  They can vary in intensity and duration.  You may experience more episodes at certain times during the year. 

Vertigo can cause you to feel like the room is moving or spinning.  Your balance may feel off and you may have difficulty or be unable to stand and walk.  Hearing may decrease, usually in one ear.  You may hear unusual sounds in your ear, such as ringing or buzzing.  Your ear may feel uncomfortable, like there is a buildup of pressure in the ear.  Nausea, vomiting, and significant sweating may occur.

The symptoms of Meniere’s disease can be both disturbing and disabling.  Symptoms may interfere with your ability to work and perform daily tasks.  Fortunately, there are treatments that can help manage symptoms and decrease the number of episodes.

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Diagnosis
You should contact your doctor if you experience symptoms of Meniere’s disease.  Lab tests may be conducted to identify and rule out other conditions that have similar symptoms.  You may be referred to a neurologist, audiologist, or ear, nose, and throat specialist.

There is not one specific test to diagnose Meniere’s disease.  Some of the more common tests are described below.

More than one type of hearing test may be conducted to identify if your hearing loss is related to an inner ear problem.  Magnetic resonance imaging (MRI) scans may be used to show the nerves and structures in your ear. 

Electronystagmography (ENG) is used to identify nerve damage in the ear.  ENG testing uses receptors to measure involuntary eye movements during certain procedures, such as caloric testing.  Caloric testing tracks involuntary eye movements that are produced when hot or cold water is placed in the ear.

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Treatment
There is no cure for Meniere’s disease, but treatments can help reduce symptoms and decrease the number of episodes.  In some people, hearing may return to normal with treatment.  A primary goal of treatment is to reduce the amount of fluid and pressure within the ear.  This may be achieved with lifestyle and dietary changes, medications, injection procedures, or surgery.  Rehabilitation can help improve balance and walking.  Assistive devices, such as a cane to help you balance or hearing aids, can improve your functional abilities.  The treatment that you receive depends on the severity and type of your symptoms.  You may need to try more than one type of treatment.

Reducing the amount of salt that you consume can decrease the amount of fluid in your ears.  A diet similar to a low-salt diet that is used for people with high blood pressure is commonly used.

It can be helpful to stop smoking.  Smoking can decrease blood flow to the nerves in the inner ear, which does not help the situation.  It can be helpful not to consume products that contain caffeine, such as coffee, tea, soda, and chocolate.  Caffeine can stimulate the nerves in the inner ear.  Regular exercise can be helpful because it increases blood flow.

Medications may be prescribed to help decrease the amount of fluid in your inner ear.  Prescription medication can be used to treat the symptoms of vertigo, nausea, or vomiting.  Surgery may be necessary if symptoms do not respond to non-surgical treatments or if symptoms are very severe.

There are a few surgical procedures that may be used to reduce symptoms of Meniere’s disease.  An endolymphatic sac decompression (ESD) is used to place a valve in the inner ear to help fluid drain.  ESD is used to decrease vertigo, but it does not improve hearing.  A labyrinthectomy is used to remove the labyrinth and nerve responsible for balance.  Rehabilitation follows the surgery to improve balance.  Like ESD, labyrinthectomy does not improve hearing. 

A vestibular neurectomy is a procedure that can cure vertigo in most cases.  It involves making an incision in the nerve responsible to “disconnect” it in the inner ear.  This procedure is the preferred surgery if a person still has good hearing.  A vestibular neurectomy does not involve the nerves used for hearing and does not decrease hearing.

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Prevention
There is no known way to prevent Meniere’s disease because an exact cause has not been identified.  You may help reduce symptoms by eliminating the risk factors that you can control, including adapting a low-salt diet and eliminating cigarettes, alcohol, and caffeine products.  Participating in rehabilitation can be helpful.  Work closely with your doctor to help formulate a treatment plan that is best for you.

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Am I at Risk
As the exact cause of Meniere’s disease is unknown, specific risk factors have not been identified.  Meniere’s disease most frequently develops when people are in their 30’s or early middle age.  Meniere’s disease appears to affect men and women equally.  The condition rarely occurs in children or older adults.

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Complications
Untreated Meniere’s disease can be very disabling and stressful.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.