Definition:
Meniere's disease is a disorder of the labyrinth in the inner ear. The labyrinth is a system of cavities and canals in the inner ear that affects hearing, balance, and eye movement.

Causes:
An increase in the volume or pressure of fluid in the labyrinth can result in Meniere's disease. The cause of these fluid changes is unknown. Possible causes may include:

• Part of the labyrinth ruptures, allowing fluid in different compartments to mix
• Scar tissue causes a blockage in the labyrinth
• Inner ear injury due to:
  
  1. Viral infection
  2. Syphilis, a type of sexually transmitted disease
  3. Autoimmune disorders
  4. Blood vessel problems
  5. High cholesterol or other fats in the blood
  6. Hormonal disorders
     
     

Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Meniere's disease include:

• Age: 20 to 60
• Race: Caucasian
• Stress
• Allergies
• Excess salt in the diet
• Excess noise

Symptoms:
The intensity of symptoms can vary from one person to another. Symptoms usually come on suddenly. They typically involve only one ear, but may involve both. These symptoms may include:

• Episodes of vertigo (spinning sensation), often accompanied by:
  Nausea or vomiting
  Sweating
  Paleness of the skin
  Weakness or falling
  In some cases, headache or diarrhea
• Hearing loss may worsen during attacks of vertigo
• Tinnitus (ringing in the ears)
• Feeling of fullness or pressure in the ear
• Poor sense of balance
• A tendency for symptoms to worsen with movement
  
  

Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include an examination of your ears. These tests may include:

• Blood tests – to check for an underlying cause
• Hearing test – this is also called an audiometry
• Electronystagmogram – a type of eye movement test
• Auditory Brainstem Response – measures electrical activity in the hearing nerve and brain stem
• Electrocochleogram – measures electrical response of the inner ear to sound
• MRI Scan – a test that uses magnetic waves to make pictures of structures inside the ear

Treatment options:

Dietary and Lifestyle Changes that may help limit symptoms:

• Bed rest during acute attacks of vertigo
• Avoid foods that are high in salt and high in sugar
• Drink adequate fluids
• Promptly begin replacing fluids lost to heat or exercise
• Avoid caffeine, aspirin, and smoking
• Minimize stress
• Avoid medications that seem to bring on or worsen symptoms
• Consider a hearing aid, if necessary
• Consider masking devices (white noise) to limit the effects of tinnitus
• Take safety measures to avoid falling
• Consider getting exercise therapy to rehabilitate the inner ear

Medications:

Drugs to treat vertigo, such as meclizine or scopolamine
Antiemetics - medications to help control nausea

Other medications that may improve hearing, control inner ear swelling, or limit overall symptoms, include:

• Antihistamines
• Cortisone drugs for a short time
• Anti-depressants or antianxiety medications
• Diuretics
• Aminoglycoside therapy (such as streptomycin or gentamycin) to permanently destroy the part of the inner ear that deals with balance
  
  

Surgical options:

Endolymphatic sac decompression - removal of a portion of inner ear bone and placing a tube in the inner ear to drain excess fluid
Labyrinthectomy - destruction or removal of the entire inner ear, which controls balance and hearing

Prevention:
There are no specific guidelines for preventing Meniere's disease. However, to help your reduce your risk, avoid the following risk factors:

• High-salt diet
• High-sugar diet
• Excess noise
• Excess alcohol
• Stress
• Smoking
• Use of drugs that can be toxic to the ear such aminoglycosides, aspirin, and quinine

Organizations:

American Academy of Otolaryngology – Head and Neck Surgery

Menieres.org

Vestibular Disorders Association

SOURCES:

The Merck Manual of Medical Information, 17th ed. Simon and Schuster, Inc.; 2000.

National Institute of Deafness and Other Communication Disorders

American Academy of Family Physicians

Last reviewed July 2003 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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