What is Meniere's Disease?
Meniere's disease can simply be described as an unstable inner ear. Since the inner ear is the site of the sense organs of hearing and balance, patients with Meniere's disease have symptoms of fluctuating hearing loss, attacks of vertigo, and ringing in the affected ear.
These symptoms usually do not develop all at once; for most people they come on gradually over a few years. There are no tests that prove a diagnosis of Meniere's disease. It is a "clinical diagnosis" based upon the patient's description of symptoms, hearing tests that confirm a progressive or fluctuating hearing loss, and tests that rule out other possible explanations for the symptoms (for example, an MRI brain scan to rule out brain tumor or multiple sclerosis).
Meniere's is also known as Secondary Endolymphatic Hydrops and/or Delayed Endolymphatic Hydrops; specifically in the case when Meniere's develops in an ear that was previously damaged from some other cause.
- It's estimated that there are 600,000-750,000 cases of Meniere's disease in the United States.
- Nearly 60,000 new cases are diagnosed annually.
- About 90 to 95 percent of patients can control their Meniere's disease with medical management.
- In most cases, it affects only one ear; 15 to 40 percent of patients are affected in both ears.
- Meniere's disease typically starts between the ages of 20 and 50 years old.
- Meniere's disease affects men and women equally.
- People suffering from Meniere's disease are more likely to suffer from depression and/or anxiety.
- People suffering from acute attacks are often not able to work because they must lie down during attacks and remain motionless, and need to sleep after an attack subsides.
Managing Meniere's Disease
The objective in managing a "fragile ear" with Meniere's disease is to pamper it by protecting the inner ear from stresses. Although not the underlying cause of Meniere's disease, there are many physiologic stresses that can overload the ear and trigger symptoms of hearing loss and vertigo.
Common triggers include salt, caffeine and alcohol intake, environmental allergies, hormonal fluctuations (such menstrual cycle or pregnancy), psychological stress, or barometric pressure changes (such as storm fronts or airplane travel). In two-thirds of Meniere patients, dietary restriction of salt, caffeine and alcohol is successful in reducing or eliminating the disabling vertigo attacks. Addition of a diuretic medicine to aid the inner ear's fluid processing capability is successful for two-thirds of those who fail to get adequate relief from dietary restriction alone.
Occasional use of a short-acting vestibular suppressant medication during attacks can also be helpful. By the time one has applied dietary restrictions, diuretics and vestibular suppressants, 90 to 95 percent of patients have their balance symptoms down to a manageable level. Only 5 to 10 percent have severe symptoms enough to consider invasive therapies.
In the 5 to 10 percent of Meniere patients who fail to respond to aggressive medical management, vertigo can be controlled in almost all cases by some form of invasive therapy. These treatments include injection of medication through the eardrum into the middle ear or surgery. Several different operations have been devised for treating intractable vertigo of Meniere's disease.
The Massachusetts Eye and Ear Infirmary is an institution known worldwide for its clinical treatment and research on Meniere's disease. Eight full-time otologists are on staff, with broad expertise in diagnosis and management of Meniere's disease and other disorders of hearing and balance, a state-of-the-art audiology and vestibular diagnostic and research capabilities, and an active multidisciplinary Meniere's disease research program.
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