By Jeffrey P. Harris, M.D., Ph.D.
About Meniere's Disease
Meniere's disease is characterized by fluctuations in hearing, episodes of dizziness, tinnitus and a feeling of pressure in the ear. The classical type has attacks of dizziness lasting for minutes to hours. Other forms have fluctuating hearing loss, tinnitus and/or pressure but no dizziness, or just attacks of dizziness alone.
There are some associated and characteristic findings that help make the diagnosis and these include a typical sensorineural (nerve-type) deafness seen on audiometry and often an ear that, despite the hearing loss, perceives sounds as being too loud and quite annoying.
Symptoms
- Symptoms vary according to the individual.
- Some patients sense that there is a slight ache in or behind the ear
- Patients with severe Meniere's disease may have repeated spells of vertigo that may come frequently and without warning
- Balance disorders can also make a patient lack concentration, have trouble focusing and have difficulty navigating through a supermarket or a shopping mall
The unpredictability of the vertigo spells can be dangerous, particularly when driving or working at any heights where precise balance is required. In severe cases, the incapacitating nature of this disorder and its unpredictability can create stress and some neurotic behavior that develops as a coping mechanism.
Over time, the severe cases gradually burn out, however, the price for this is usually good hearing. It may however, take many years before the attacks eventually disappear. It is rare for this disease to be hereditary (less than 10%). Up to 40% of the cases will eventually become bilateral. However, if bilateral disease has not occurred within the first five years, the chances of getting it in the other ear drops significantly.
Causes
- There are many forms of Meniere's disease and several possible causes. the majority of cases are idiopathic, that is, that no specific cause will be identified. Causes may include:
- head or ear trauma
- middle ear infection
- autoimmune or allergy problems
- inner ear syphilis
- various viruses
The end result is that the inner ear cannot get rid of the inner ear fluid (endolymph) that is constantly being produced, The normal site within the inner ear that resorbs fluid is the endolymphatic sac that lies under the mastoid bone and up against the brain covering known as dura mater.
Because fluid overload of the inner ear is present, factors that affect the retention of fluid in the body will have an adverse affect on this disease. Reducing your salt intake is very important as the more salt one consumes, the more water that is retained. Similarly, in women, hormone shifts can cause fluid retention and aggravate the problem. In fact, some women will have exacerbations premenstrually, when they take birth control pills or estrogen replacement hormones.
Diagnosis
Your physician will first rule out other conditions that may be causing the symptoms of inner ear disease. For this reason, a hearing test and some blood work will be ordered. Depending on the results, additional tests may be ordered, such as:
- BERA (brainstem evoked response audiometry) to look at the functioning of the auditory nerve and brain
- ENG (electronystagmography) to assess possible damage to the inner ear balance system
- ECoG (elecrocochleography) to determine if the inner ear had an overabundance of fluid
- MRI to visualize the nerves and brain
These tests are helpful in confirming the cause, the amount of damage, and, in some cases, to determine which ear is affected by the illness.
The ear will look normal in Meniere's disease and there will be no evidence of middle ear or Eustachian tube problems. Unfortunately, it is common for an untrained observer to conclude that ear infections are present and antibiotics and decongestants are often prescribed to be on the “safe side.”
For that reason, it's important to see a specialist in ear disorders for proper diagnosis and treatment.