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5018 NE 15 AVE · PORTLAND, OR 97211 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · VESTIBULAR.ORG

Ménière’s Disease
By P.J. Haybach, MS, RN, and the Vestibular Disorders Association, with revisions by Dr. Joel
Goebel

In 1861 the French physician Prosper differ from one report to the next and
Ménière theorized that attacks of vertigo, from one country to the next. The
ringing in the ear (tinnitus) and hearing National Institutes of Health estimates
loss came from the inner ear rather than that about 615,000 people in the U.S.
from the brain, as was generally believed have Ménière’s disease and that 45,500
at the time. Once this idea was accepted, new cases re-diagnosed each year.2
the name of Dr. Prosper Ménière began
its long association with this inner ear Causes
disease and with inner ear balance The exact cause and reason why
disorders in general. Ménière’s disease starts is not yet known.
Many theories have been proposed over
What is Ménière’s disease? the years. They include: circulation
Ménière’s disease is a chronic, incurable problems, viral infection, allergies, an
vestibular (inner ear) disorder defined in autoimmune reaction, migraine, and the
1995 by the Committee on Hearing and possibility of a genetic connection.
Equilibrium of the American Academy of
Otolaryngology—Head and Neck Surgery Experts aren’t sure what generates the
as “the idiopathic syndrome of symptoms of an acute attack of
endolymphatic hydrops.”1 In plain Ménière’s disease. The leading theory is
language, this means that Ménière’s that they result from increased pressure
disease, a form of endolymphatic of an abnormally large amount of
hydrops, produces a recurring set of endolymph in the inner ear and/or from
symptoms as a result of abnormally large the presence of potassium in an area of
amounts of a fluid called endolymph the inner ear where it doesn’t belong.
collecting in the inner ear. These conditions may be due to breaks
in the membrane separating endolymph
Ménière’s disease can develop at any age, from the other inner ear fluid, perilymph.
but it is more likely to happen to adults Some people with Ménière’s disease find
between 40 and 60 years of age. The that certain events and situations, some-
exact number of people with Ménière’s times called triggers, can set off attacks.
disease is difficult to measure accurately These triggers include stress, overwork,
because no official reporting system fatigue, emotional distress, additional
exists. Numbers used by researchers

© Vestibular Disorders Association ◦ vestibular.org ◦ Page 1 of 6

illnesses, pressure changes, certain • blurry vision or eye jerking
foods, and too much salt in the diet. • nausea and vomiting
• cold sweat, palpitations or rapid
Progression of symptoms pulse
Common symptoms of a Ménière’s • trembling
disease attack do not reflect the entire
picture of the disorder, because Following the attack, a period of extreme
symptoms vary before, during, between, fatigue or exhaustion often occurs,
and after attacks, and also during the prompting the need for hours of sleep.
late-stage of Ménière’s disease.
The periods between attacks are
Ménière’s disease may start with symptom free for some people and
fluctuating hearing loss, eventually symptomatic for others. Many symptoms
progressing to attacks of vertigo and have been reported after and between
dizziness. attacks:
• anger, anxiety, fear, worry
Oncoming attacks are often preceded by • appetite change
an “aura,” or the specific set of warning • clumsiness
symptoms, listed below. Paying attention • concentration difficulty,
to these warning symptoms can allow a distractibility, tendency to grope for
person to move to a safe or more words
comfortable situation before an attack. • diarrhea
• balance disturbance • fatigue, malaise, sleepiness
• dizziness, lightheadedness • headache, heavy head sensation
• headache, increased ear pressure • lightheadedness (faintness)
• hearing loss or tinnitus increase • loss of self-confidence and self-
• sound sensitivity reliance
• vague feeling of uneasiness • nausea, queasiness, motion sickness
• neck ache or stiff neck
During an attack of early-stage Ménière’s • palpitations or rapid pulse, cold
disease, symptoms include: sweat
• spontaneous, violent vertigo • sound distortion and sensitivity
• fluctuating hearing loss • unsteadiness (sudden falls,
• ear fullness (aural fullness) and/or staggering or stumbling, difficulty
tinnitus turning or walking in poorly lit areas,
tendency to look down or to grope
In addition to the above main symptoms, for stable handholds)
attacks can also include: • vision difficulties (problems with
• anxiety, fear blurring, bouncing, depth perception,
• diarrhea glare intensification, focusing,

© Vestibular Disorders Association ◦ vestibular.org ◦ Page 2 of 6

 watching movement; difficulty exists to cure Ménière’s disease.
looking through lenses such as However, medical treatments exist that
binoculars or cameras) can help manage it.
• vomiting
Treatment
Late-stage Ménière’s disease refers to a Existing treatments fall into two
set of symptoms rather than a point in categories. Some treatments aim at
time. Hearing loss is more significant and reducing the severity of an attack while it
is less likely to fluctuate. Tinnitus and/or is occurring; some treatments attempt to
aural fullness may be stronger and more reduce the severity and number of
constant. Attacks of vertigo may be attacks in the long term. Experts feel
replaced by more constant struggles with these medical treatments provide some
vision and balance, including difficulty degree of improvement in 60–80% of the
walking in the dark and occasional treated people.4 Gentamicin is > 80%
sudden loss of balance. Sometimes, drop effective at control of vertigo.
attacks of vestibular origin (Tumarkin’s
otolithic crisis3) occur in this stage of The most conservative long-term
Ménière’s disease and are characterized treatment for Ménière’s disease in the
by sudden brief loss of posture without U.S. involves adhering to a reduced-
loss of consciousness. Some of these sodium diet and using medication that
late-stage symptoms can become more helps control water retention (diuretics or
problematic in conditions of low lighting, “water pills”). The goal of this treatment
or with fatigue, or when a person is is to reduce inner-ear fluid pressure.
exposed to visually stimulating situations. Some physicians, more commonly outside
of the U.S., also weigh the potential
Duration and frequency of attacks: efficacy of using betahistine HCl (Serc) as
Attacks can last from 20 minutes to 24 a vestibular suppressant for Ménière’s
hours. They can occur with the frequency disease.5
of many attacks each week; or they can
be separated by weeks, months, and Medications can be used during an
even years. The unpredictable nature of attack to reduce the vertigo,
this disease makes managing it nausea/vomiting or both. Some drugs
challenging. It also complicates the ability used for this include diazepam (Valium),
of scientists and physicians to study it. lorazepam (Ativan), promethazine
(Phenergan), dimenhydrinate
Is there a cure? (Dramamine Original Formula), and
To “cure” a disease means to eliminate meclizine hydrochloride (Antivert,
the root cause of the disease and reverse Dramamine Less Drowsy Formula).
the damage it has inflicted (on the inner
ear, in this case). No treatment currently

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Vestibular rehabilitation therapy is instance, physical therapy is useful to
sometimes used to help with the help the brain compensate from the loss
imbalance that can plague people of inner ear function due to surgery.
between attacks. Its goal is to help
retrain the ability of the body and brain to Prognosis
process balance information. When It is difficult to predict how Ménière’s
successful, this can help a person regain disease will affect a person’s future.
confidence in the ability to move about. Symptoms can disappear one day and
never return. Or they might become so
When conservative treatments don’t severe that they are disabling.
work: For the 20–40% of people who do
not respond to medication or diet, a Coping
physician may recommend a treatment Coping with Ménière’s disease is
that involves more physical risk. One challenging because attacks are
such method, a intratympanic unpredictable, it is incurable, some of the
gentamicin, destroys vestibular tissue symptoms are not obvious to others, and
with injections into the ear of the most people know virtually nothing about
aminoglycoside antibiotic gentamicin. the disorder. Many people with Ménière’s
Recently, intratympanic steroid injections disease are thrust into the role of
have been used with less risk of hearing educator—they must teach themselves,
loss and persistent imbalance. their family, friends, coworkers, and
sometimes even health care professionals
Another less conservative treatment about the disorder and how it impacts
method involves surgery. Two categories them.
of surgery are available. The goal of the
first type is to relieve the pressure on the Key features of communicating with
inner ear. Surgery to reduce pressure is family and friends include informing
not as widely used now as it was in the them about what might happen with the
past due to questions about its long-term onset of an acute attack and how they
effectiveness. can help. If a low-sodium diet is
effective, family and friends should be
The goal of the second type of surgery is informed about how important it is for
to block the movement of information them to support adherence to the diet
from the affected ear to the brain. The regimen. Changes in lifelong eating
process involves either destroying the patterns can be easier with the
inner ear so that the ear does not assistance of others.
generate balance information to send to
the brain, or destroying the vestibular Managing an acute attack involves
nerve so that balance information is not preparation. This includes consulting with
transmitted to the brain. In either a physician about any appropriate drugs

© Vestibular Disorders Association ◦ vestibular.org ◦ Page 4 of 6

that can be taken when an acute attack Surgery Foundation, Inc.
occurs, and deciding ahead of time when 1995;113(3):181–185.
it is appropriate to go to a hospital. 2. National Institute on Deafness and
Other Communication Disorders.
During an attack, it is helpful to lie down
Ménière’s disease.
in a safe place with a firm surface, and http://www.nidcd.nih.gov/health/ba
avoid any head movement. Sometimes lance/ meniere.asp, accessed
keeping the eyes open and fixed on a February 16, 2011.
stationary object about 18 inches away is 3. Tumarkin A. The otolithic
catastrophe: a new syndrome.
helpful. In order to control dehydration, a
British Medical Journal. 1936;1:175–
doctor should be called if fluid intake is 177.
not possible over time due to persistent 4. Torok N. The Old and New in
vomiting. Ménière’s Disease. Laryngoscope.
1977;87(11):1870–1877.
5. Hain TC. Serc (betahistine).
After an acute attack subsides, it is not www.dizziness-and-
uncommon to want to sleep for several balance.com/treatment/drug/serc.h
hours. Resting in bed for a short time is tml, accessed February 16, 2011.
appropriate, if the person is exhausted.
But it is also important for the person to Further reading
get up and move around as soon as Some helpful documents available from the
possible so that the brain readjusts to the Vestibular Disorders Association include the
changed balance signals. Precautions following:
need to be taken in this process to • Secondary Endolymphatic Hydrops
• Dietary Considerations with
accommodate any new balance
Endolymphatic Hydrops, Ménière’s
sensations.
Disease, and Vestibular Migraine
• Surgery for Peripheral Vestibular
Successfully coping with symptoms Disorders
involves understanding the disease. • Ménière’s Disease—What You Need to
Talking with health care providers, Know
communicating with other people who are • Vestibular Injury: Compensation,
experiencing the same disease, and read- Decompensation, and Failure to
ing books and articles about the topic are Compensate
all helpful methods of learning more about • Vestibular Rehabilitation: An Effective,
Ménière’s disease. Evidence- Based Treatment

References © 2013 Vestibular Disorders Association

1. Committee on Hearing and
Equilibrium Guidelines for the VEDA’s publications are protected under
Diagnosis and Evaluation of copyright. For more information, see our
permissions guide at vestibular.org.
Therapy in Ménière’s Disease.
Otolaryngology—Head and Neck This document is not intended as a substitute
for professional health care.

© Vestibular Disorders Association ◦ vestibular.org ◦ Page 5 of 6

 TH
5018 NE 15 AVE · PORTLAND, OR 97211 · FAX: (503) 229-8064 · (800) 837-8428 · [email protected] · VESTIBULAR.ORG

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