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Meniere's syndrome
medical conditions

Meniere's syndrome

Explore the available health information, treatment context, and integrative evidence for Meniere's syndrome.

Background
  • Ménière's syndrome, also called idiopathic endolymphatic hydrops, or Ménière's disease, is a disorder of the inner ear. Although the cause is unknown, Ménière's syndrome is thought to result from an abnormality in the inner ear fluids.
    About 100,000 individuals per year develop Ménière's syndrome.
  • Ménière's syndrome is one of the most common causes of dizziness. In most cases only one ear is involved, but both ears may be affected in about 15% of individuals.
  • Ménière's syndrome can cause severe dizziness, a roaring or ringing
    sound in the ears called tinnitus, sporadic or spontaneous hearing loss, and the feeling of ear pressure or pain. Meniere's syndrome causes bilateral hearing loss in 5-20% of individuals
    suffering from the condition.
  • Symptoms of Ménière's syndrome
    usually last from 20 minutes to two hours or more. Ménière's syndrome
    typically starts between the ages of 20-50 years. Men and women are affected in equal numbers.
  • There is no cure for Ménière's disease. However, individuals may be able to control symptoms by changing the diet (see Treatment) or taking medicine so that the body retains less fluid. Severe cases may require surgery.
Signs and Symptoms
  • The symptoms of Ménière's syndrome are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Tinnitus and fullness of the ear in Ménière's syndrome may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and seem distorted in the affected ear.
  • Ménière's syndrome generally occurs in only one ear. In rare cases, both ears can be affected. As the disease progresses, hearing loss may be more pronounced and less likely to fluctuate with attacks, and tinnitus and ear fullness may be stronger and more constant. The vertigo (dizziness) attacks may subside over time.
  • Vertigo is usually the most troublesome of all the symptoms of Ménière's syndrome. Vertigo is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. Vertigo may last for 20 minutes to two hours or longer.
  • During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may last for days. The symptoms of Ménière's syndrome may be only a minor nuisance, or can be disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.
Diagnosis
  • The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) has proposed diagnosis criteria for Ménière's syndrome. According to AAO-HNS guidelines, a definite diagnosis of Ménière's syndrome requires: two spontaneous episodes of vertigo
    each lasting 20 minutes or longer (with no time frame); ringing in the ear (tinnitus) or feeling of fullness in the ear; and documented hearing loss on a hearing test. Vertigo must be present and at least one of the other symptoms for a diagnosis of Ménière's syndrome.
  • A doctor will take a history of the frequency, duration, severity, and character of attacks, the duration of hearing loss or whether it has been changing, and whether the individual has experienced tinnitus or fullness in either or both ears. The individual may be asked whether there is history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past. The individual may be asked questions about their general health, such as whether diabetes, high blood pressure, high blood cholesterol, thyroid, or neurologic or emotional disorders are present. Tests may be ordered to look for these conditions. When the history has been completed, diagnostic tests will check hearing and balance functions.
  • For hearing: An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the individual's ability to distinguish between words like "sit" and "fit") is often diminished in the affected ear.
  • For balance: An ENG (electronystagmograph) may be performed to evaluate balance function. In a darkened room, recording electrodes are placed near the eyes. Warm and cool water or air is gently introduced into each ear canal. Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50% of individuals, the balance function is reduced in the affected ear. Rotational testing or balance platform may also be performed to evaluate the balance system.
  • Electrocochleography: An electrocochleograph (ECoG) measures the electrical potentials generated in the inner ear as a response to sound. An ECoG may indicate increased inner ear fluid pressure in some cases of Ménière's syndrome.
  • Auditory brain stem response: The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT), or magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière's syndrome.
  • Magnetic resonance imaging (MRI): An MRI uses a magnetic field and radio waves to create cross-sectional images of the head and body. A doctor can use these detailed, clear images to identify and diagnose a wide range of conditions. MRI may be performed to rule out central nervous system disorders that can imitate Ménière's syndrome, such as acoustic neuroma (a noncancerous brain tumor of the acoustic nerve, which carries sound from the inner ear to the brain), Arnold-Chiari malformation, and multiple sclerosis.
Complications
  • Complications of Ménière's syndrome may include: an increased risk of falling; an increased risk of an accident while driving a car or operating heavy machinery; permanent, partial, or total hearing loss in the affected ear; and an increased risk of depression or anxiety in dealing with the disease.
Treatment
  • The goal of treatment for Ménière's syndrome is to manage signs and symptoms, such as dizziness, and prevent or decrease the number of attacks. Prescription drugs, over-the-counter (OTC) medicines, and lifestyle changes (such as diet and exercise) may help decrease the number and severity of Ménière's syndrome attacks.
  • A low salt diet and a prescription diuretic, or water pill, (such as hydrochlorothiazide), may reduce the frequency of attacks of Ménière's syndrome in some individuals. Because diuretic medications cause the individual to urinate more frequently, their body may become depleted of certain minerals, such as potassium. Healthcare providers may recommend taking a potassium supplement or eating three or four extra servings of potassium-rich foods a week, such as bananas when taking diuretic medications that may cause potassium to be lost, including furosemide (Lasix®).
  • Anti-vertigo medications, such as meclizine (Antivert®) may provide temporary relief. Anti-nausea medication is sometimes prescribed, such as prochlorperazine (Compazine®). Anti-anxiety drugs may also be used, such as alprazolam (Xanax®). Anti-vertigo, anti-nausea, and anti-anxiety medications may cause drowsiness. Alprazolam is in a class of drugs called benzodiazepines. These medications may cause physical and psychological addiction.
  • Lifestyle changes: Healthcare professionals recommend that individuals with Ménière's disease: avoid caffeine, smoking, and alcohol; get regular sleep; eat a healthy diet, including fresh fruits and vegetables and limiting meats and fatty foods; and avoid foods that contain MSG or monosodium glutamate. Prepackaged food products and Chinese food include MSG, which contains sodium. MSG can contribute to fluid retention and worsen symptoms; and limit stress. Stress may aggravate the vertigo and tinnitus of Ménière's syndrome. Stress avoidance or counseling may be advised.
  • If vertigo appears without warning, the individual should not drive. Failure to control the vehicle may be hazardous to the individual and others. It is also best to avoid ladders, scaffolds, and swimming.
  • Middle ear injections: A middle ear injection consists of a healthcare professional injecting gentamicin (Garamycin®) in the inner ear, through the eardrum, and into the inner ear. Injecting gentamycin into the ear destroys the balance nerve endings in the inner ear, sparing the hearing nerve endings. This reduces the balancing function of the individual's ear, and their other ear assumes responsibility for balance. The procedure, which can be performed with local anesthesia in a doctor's office, often reduces the frequency and severity of vertigo attacks. Gentamycin is also effectively used as an antibiotic for certain infections. Side effects of middle ear injections are further hearing loss. Middle ear injections are not commonly used.
  • Injections with a steroid, such as dexamethasone (Decadron®), may also help control vertigo attacks in some individuals. Although dexamethasone injections may be slightly less effective than gentamicin, dexamethasone is less likely than gentamicin to cause further hearing loss.
  • Surgery: If the vertigo attacks associated with Ménière's syndrome are severe and debilitating and medical treatments do not help, surgery may be an option.
  • Endolymphatic sac procedures: Endolymphatic sac procedures are surgical procedures that reduce the swelling caused by endolymph (an inner ear fluid) buildup. In endolymphatic sac decompression, some of the bone surrounding the inner ear is removed. In some cases, endolymphatic sac decompression is coupled with the placement of an endolymphatic shunt, a tube that drains excess fluid from the inner ear. Another surgical approach, called a sacculotomy, involves implanting a permanent, tack-like device that allows endolymph to drain out of the inner ear whenever pressure builds up.
  • Labyrinthectomy: A labyrinthectomy removes the entire inner ear sense organ (vestibular labyrinth). The operation may be an option if antibiotic injections do not help and the individual has near-total or total hearing loss in the affected ear.
  • Vestibular neurectomy: A vestibular neurectomy involves cutting the nerve that controls balance (vestibular nerve). When hearing loss is severe or Ménière's syndrome involves intense vertigo, a vestibular neurectomy may be done to surgically destroy the entire inner ear. The individual's other ear then takes over the balance function.
  • Rehabilitation: If the individual experiences problems with balance between attacks, they may benefit from vestibular rehabilitation therapy. The goal of this therapy, which may include exercises and activities performed during therapy sessions and at home, is to help the body and brain regain the ability to process information correctly.
References
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