Affecting men and women equally between the ages of 20 and 50 years old, Meniere's disease is a disorder of the inner ear that causes the following symptoms:
- Dizziness (vertigo) is the most troublesome symptom for most patients. Attacks of vertigo (whirling or spinning) begin unexpectedly. These are often accompanied by nausea and vomiting. A typical spell may last for hours at a time. A sense of fatigue or imbalance can continue long after the vertigo has subsided. The attacks of vertigo can come and go unpredictably.
- Hearing loss usually affects only one ear. In the early stages of Meniere's disease your hearing loss may be mild or it may fluctuate (getting better and worse on its own). In later stages, hearing loss may become severe and permanent.
- Ringing in the ear (tinnitus) often occurs. In most cases, tinnitus is a by-product of the hearing loss. Many patients also experience pressure or fullness in their ears. Sometimes the pressure increases before or during a dizzy spell.
- Pressure in the ear
Meniere's disease is caused by an overproduction of fluid within the inner ear. Excessive fluid pressure interferes with the function of the hair cells located in that area. Sudden increases in pressure make the ear feel stopped up and cause vertigo.
Most cases of Meniere's disease have no known cause. In some cases, it can be associated with head trauma or middle or inner ear infections. Allergies and autoimmune disorders may also bring about the onset of this condition.
At Mount Sinai, our hearing and balance experts have been treating patients suffering from Meniere’s disease for more than 50 years. Our team has vast expertise with all forms of treatment, and we personalize each patient’s treatment plan.
Diagnosis and Treatment for Meniere’s Disease
Abnormal results of a caloric stimulation test of eye reflexes can indicate a sign of Meniere’s disease. An electrocochleography, MRI scan or electronystagmography (ENG) may also be recommended to decipher Meniere’s disease from other forms of vertigo. The vertigo associated with Meniere's disease can usually be controlled with medications and dietary changes. If those measures do not work, gentamicin injections might give lasting relief. Surgery is an option when other measures fail.
Medications that are effective for Meniere's disease include:
- Diuretics are the most commonly prescribed maintenance medications for Meniere's disease. Diuretics work by restricting the overproduction of fluid in the inner ear. Diuretics are long-term medications. They help reduce the number of vertigo attacks, and in some cases, they help stabilize hearing. Commonly used diuretics are Diamox (acetazolamide) and Dyazide (triamterene/HCTZ).
- Meclizine (Antivert or Bonine) is the most commonly prescribed medication for the control of vertigo. Dramamine, available over-the-counter, is milder but might also be effective.
- Valium in small doses may be helpful when other medications fail to control the vertigo.
Cutting back on salt will help keep the inner ear fluid low and help prevent vertigo. For most patients, 2000 mg of sodium a day is the target value. When symptoms are severe, 1500 mg a day is advisable. A low-salt diet consists of: not adding salt to food, avoiding prepared foods, and tallying the sodium intake by reading food labels.
Injection Therapy for Meniere’s Disease
Gentamicin is an antibiotic that is toxic (poisonous) to the cells of the inner ear. By selectively targeting the specialized cells of the balance organ, gentamicin can reduce the incidence of vertigo while preserving hearing in the ear. The effect of gentamicin injections is permanent—once the balance function (or hearing) is lost in that ear it does not return.
The medication is administered in the office. The injections are performed at monthly intervals until either dizziness, imbalance, or hearing loss occur. Most patients receive between one and three treatments, although the number may vary depending on the response.
The results of Gentamicin are: relief of vertigo spells in 70 percent of patients, permanent hearing loss in 30 percent. Patients may also experience imbalance or unsteady gait. This is usually temporary, but may occasionally require treatment with physical therapy.
Dexamethasone is a strong form of cortisone that can be injected into the inner ear. It is sometimes effective in treating severe Meniere’s disease, but the effect is not permanent.
Surgical Procedures for Meniere's Disease
If the incidences of vertigo are not controlled by medications, surgery may be recommended. Surgical procedures can eliminate the frequent spells of vertigo that occur in Meniere's disease; however, no surgery has been found to improve the hearing loss.
The decision about which operation depends on the patient's age and health, medical condition, and hearing status.
Endolymphatic sac (shunt) surgery
Endolymphatic sac, or shunt, surgery strives to decompress the inner ear fluid by making an incision in the endolymphatic sac. The procedure is safe, and the recovery is usually quick. In our experience, endolympahtic sac surgery has a rate of cure of vertigo of about 70 percent and a risk of hearing loss of about 5 percent.
Vestibular nerve section
Vestibular nerve section is a highly effective operation that relieves vertigo attacks while preserving the hearing. In this operation, the balance nerve is isolated under the microscope and cut. The operation provides excellent relief in most patients, with minimal side effects.
Vestibular nerve section is performed through an incision behind the ear. The balance nerve is identified as it travels between the ear and the brain. Under the microscope, the balance fibers are separated from the hearing nerve fibers and are cut.
Vestibular nerve section is very effective. More than 90% of patients will have complete relief of their vertigo. Hearing is preserved at the preoperative level about 80% of the time. Patients usually stay in hospital 2 to 3 days after surgery, and the balance usually recovers over 3 or 4 weeks.
Labyrinthectomy is the operation with highest rate of cure of vertigo, but always causes a total loss of hearing in the operated ear. It is only recommended to patients who have very poor hearing. In this operation, the balance canals are destroyed and so the source of the vertigo is permanently removed. The recovery after surgery is similar to vestibular nerve section.