Frustrating Hearing: Ménière's Disease

Feel like you’re spin­ning when you’re stand­ing? Or do you hear ring­ing or a roar­ing sound when it’s qui­et? You have have an inner ear issue called Ménière’s dis­ease. Learn more below!

What caus­es Ménière’s dis­ease?
The symp­toms of Ménière’s dis­ease are asso­ci­at­ed with a change in flu­id vol­ume with­in a por­tion of the inner ear known as the labyrinth. The labyrinth has two parts: the bony labyrinth and the mem­bra­nous labyrinth. The mem­bra­nous labyrinth, which is encased by bone, is nec­es­sary for hear­ing and bal­ance and is filled with a flu­id called endolymph. When your head moves, endolymph moves, caus­ing nerve recep­tors in the mem­bra­nous labyrinth to send sig­nals to the brain about the body’s motion. An increase in endolymph, how­ev­er, can cause the mem­bra­nous labyrinth to bal­loon or dilate, a con­di­tion known as endolym­phat­ic hydrops.

Many experts on Ménière’s dis­ease think that a rup­ture of the mem­bra­nous labyrinth allows the endolymph to mix with per­i­lymph, anoth­er inner ear flu­id that occu­pies the space between the mem­bra­nous labyrinth and the bony inner ear. This mix­ing, sci­en­tists believe, can cause the symp­toms of Ménière’s dis­ease. Sci­en­tists are inves­ti­gat­ing sev­er­al pos­si­ble caus­es of the dis­ease, includ­ing envi­ron­men­tal fac­tors, such as noise pol­lu­tion and viral infec­tions, as well as bio­log­i­cal factors.

What are the symp­toms of Ménière’s dis­ease?
The symp­toms of Ménière’s dis­ease occur sud­den­ly and can arise dai­ly or as infre­quent­ly as once a year. Ver­ti­go, often the most debil­i­tat­ing symp­tom of Ménière’s dis­ease, typ­i­cal­ly involves a whirling dizzi­ness that forces the suf­fer­er to lie down. Ver­ti­go attacks can lead to severe nau­sea, vom­it­ing, and sweat­ing and often come with lit­tle or no warning.

Some indi­vid­u­als with Ménière’s dis­ease have attacks that start with tin­ni­tus (ear nois­es), a loss of hear­ing, or a full feel­ing or pres­sure in the affect­ed ear. It is impor­tant to remem­ber that all of these symp­toms are unpre­dictable. Typ­i­cal­ly, the attack is char­ac­ter­ized by a com­bi­na­tion of ver­ti­go, tin­ni­tus, and hear­ing loss last­ing sev­er­al hours. Peo­ple expe­ri­ence these dis­com­forts at vary­ing fre­quen­cies, dura­tions, and inten­si­ties. Some may feel slight ver­ti­go a few times a year. Oth­ers may be occa­sion­al­ly dis­turbed by intense, uncon­trol­lable tin­ni­tus while sleep­ing. Ménière’s dis­ease suf­fer­ers may also notice a hear­ing loss and feel unsteady all day long for pro­longed peri­ods. Oth­er occa­sion­al symp­toms of Ménière’s dis­ease include headaches, abdom­i­nal dis­com­fort, and diar­rhea. A per­son­’s hear­ing tends to recov­er between attacks but over time becomes worse.

How is Ménière’s dis­ease diagnosed?

Through the use of sev­er­al types of hear­ing tests, physi­cians can char­ac­ter­ize hear­ing loss as being sen­so­ry, aris­ing from the inner ear, or neur­al, aris­ing from the hear­ing nerve. Record­ing the audi­to­ry brain stem response, which mea­sures elec­tri­cal activ­i­ty in the hear­ing nerve and brain stem, is use­ful in dif­fer­en­ti­at­ing between these two types of hear­ing loss. Elec­tro­cochleog­ra­phy, record­ing the elec­tri­cal activ­i­ty of the inner ear in response to sound, helps con­firm the diagnosis.

To test the vestibu­lar or bal­ance sys­tem, physi­cians irri­gate the ears with warm and cool water or air. This pro­ce­dure, known as caloric test­ing, results in nys­tag­mus: rapid eye move­ments that can help a physi­cian ana­lyze a bal­ance dis­or­der. Since tumor growth can pro­duce symp­toms sim­i­lar to Ménière’s dis­ease, an MRI is a use­ful test to deter­mine whether a tumor is caus­ing the patien­t’s ver­ti­go and hear­ing loss.

How is Ménière’s dis­ease treat­ed?
There is no cure for Ménière’s dis­ease; how­ev­er, the symp­toms of the dis­ease are often con­trolled suc­cess­ful­ly by reduc­ing the body’s reten­tion of flu­ids through dietary changes (such as a low-salt or salt-free diet and no caf­feine or alco­hol) or med­ica­tion. Changes in med­ica­tions that either con­trol aller­gies or improve blood cir­cu­la­tion in the inner ear may help. Elim­i­nat­ing tobac­co use and reduc­ing stress lev­els are more ways some peo­ple can lessen the sever­i­ty of their symptoms.

Dif­fer­ent sur­gi­cal pro­ce­dures have been advo­cat­ed for patients with per­sis­tent, debil­i­tat­ing ver­ti­go from Ménière’s dis­ease. Labyrinthec­to­my (removal of the inner ear sense organ) can effec­tive­ly con­trol ver­ti­go, but sac­ri­fices hear­ing and is reserved for patients with non­func­tion­al hear­ing in the affect­ed ear. Vestibu­lar neurec­to­my, selec­tive­ly sev­er­ing a nerve from the affect­ed inner ear organ, usu­al­ly con­trols the ver­ti­go while pre­serv­ing hear­ing, but car­ries sur­gi­cal risks. Recent­ly, the admin­is­tra­tion of the oto­tox­ic antibi­ot­ic, gen­tamycin direct­ly into the mid­dle ear space has gained pop­u­lar­i­ty world­wide for the con­trol of the ver­ti­go of Ménière’s disease.