Meniere’s disease (also called Meniere’s syndrome) is a disorder of the inner ear. It most commonly affects adults between ages 40 and 70, but in rare cases can affect younger children and older adults.
More than 600,000 people in the United States have been diagnosed with Meniere’s disease.
The exact cause of Meniere’s disease is not known, but there are two common theories.
The first theory is that excess fluid accumulates in the inner ear and disturbs the sensitive nerve endings that control hearing and balance. The second is that blood flow through the small arteries supplying the inner ear results in a lack of oxygen leading to a “stroke” in the inner ear.
The two main symptoms of Meniere’s disease are hearing loss and bouts of vertigo that lasts 20 minutes or more.
Other symptoms may include inner ear pressure and a ringing or buzzing in the ear.
Meniere’s disease is often misdiagnosed when other conditions are actually responsible for the symptoms. That’s why it is important to have a physician specializing in otology or otolaryngology be the one to diagnose Meniere’s disease.
Most experts agree now that without hearing loss, the diagnosis of Meniere’s disease is extremely unlikely. A few diagnostic tests can be used in the work-up of patients suspected of having Meniere’s disease, but these tests are often used only to confirm the diagnosis.
Approximately 60 percent to 70 percent of people with Meniere’s disease can have significant improvement in their symptoms through dietary and lifestyle modifications alone.
- Limiting salt intake to about 2,000 mg a day
- Avoiding caffeine and alcohol
- Avoiding stimulants such as energy drinks
- Stopping smoking and avoiding all tobacco products
- Eating a diet low in cholesterol and fat
- Drinking plenty of fluids, most importantly water
- Exercising regularly
- Maintaining good sleep habits
- Reducing unnecessary stress
If making these changes does not work, medications may help, including:
- Diuretics to help remove excess fluid in the inner ear
- Betahistine, a compound that increases oxygen delivery by dilating the small blood vessels in the inner ear
- Steroids taken orally or by injections made directly into the middle ear through the eardrum
If lifestyle changes and medications do not work, a variety of surgical options are available.
Several steps are involved in choosing the type of procedure that will be most appropriate and most effective in treating Meniere’s disease.
These steps include:
- A trial of many of the non-invasive options
- Extensive hearing and balance testing
- Determining the degree of residual hearing in the afflicted ear
- A formal evaluation by an otologist
Your otologist will recommend the most appropriate and effective option for your particular case, and will answer all of your questions about the procedure.
Minimally invasive procedures include:
Endolymphatic sac surgery, which involves drilling away the mastoid bone behind the ear and decompressing the small sac that controls the fluid pressure regulation of the inner ear.
This outpatient surgery is successful in about 70 percent of patients and carries minimal risk to the hearing.
Intratympanic injections that use Gentamicin, an antibiotic that is toxic to the balance system of the inner ear, to destroy the faulty balance system in the affected ear.
Injections are done in the clinic, and are successful in nearly 90 percent of patients. The procedure does carry a small risk of hearing loss.
A Meniett device that is worn in the ear canal after a small tube (tympanostomy tube) is placed in the eardrum in the clinic. The device pumps air pressure through the tube to counteract the abnormal inner ear pressure.
This device is rarely covered by insurance and can be expensive. Data on the success rate is also very limited.
More involved surgical procedures include:
Vestibular neurectomy involves opening the skull behind the ear and exposing the balance nerve within the brain. The balance nerve is then cut to prevent abnormal balance information from being sent from the ear to the brain.
This procedure typically requires a short hospitalization and is successful 80 percent to 90 percent of the time.
Labyrinthectomy involves drilling away the mastoid bone to expose the balance portion of the inner ear and removing the three balance canals in the inner ear.
This procedure causes total deafness in that ear, but controls dizziness in close to 100 percent of patients.