Meniere’s disease primarily affects people between the ages of 40 and 50. Women are affected more often than men. Approximately 13 out of every 100,000 people in Central Europe are newly diagnosed with Meniere’s disease each year.
In addition, Meniere’s disease can also be associated with other conditions. In such cases, medical professionals refer to these as comorbidities. The most common of these are migraines and rheumatoid arthritis.
Meniere’s disease is a disorder of the inner ear characterized by episodic attacks of vertigo, hearing loss, and tinnitus. This combination is considered the classic triad of symptoms.
However, not all patients experience all of these symptoms simultaneously from the outset. Some initially notice only one symptom, such as sudden hearing loss or ringing in the ears.
The condition is named after the French physician Prosper Menière. In 1861, Dr. Menière first described the connection between vertigo, hearing problems, and the inner ear. This was significant at the time because vertigo had previously been attributed primarily to the brain.
The spelling “Morbus Meniere” is also commonly found; in German, the correct form is usually “Morbus Menière.”
The condition usually affects only one ear. In rare cases, however, both ears may be affected as the disease progresses. It is particularly distressing that an attack can occur suddenly and that those affected experience their surroundings as spinning during the episode. Frequent attacks are also very distressing.
The exact causes of the episodic vertigo are still not fully understood.
The primary trigger is generally considered to be endolymphatic hydrops (excessive production of endolymph) combined with impaired inner ear homeostasis.
This fluid (lymph) is essential for the function of the sensory cells in the cochlea and the vestibular system. If the balance between endolymph and perilymph is disrupted, the pressure in the inner ear changes. This causes uncontrolled leakage of lymph, which the brain mistakenly interprets as a change in the body’s position. This is what causes the sensation of vertigo.
The spontaneous reattachment of the torn membranes, in turn, eventually brings the vertigo episode to an end.
Risk factors under discussion include a family history of the condition, circulatory disorders, autoimmune processes, and other comorbidities. In some cases, multiple family members are affected. Therefore, a positive family history is particularly important when the disease begins in childhood or young adulthood. Additionally, it sometimes occurs alongside migraine or rheumatoid arthritis.
Meniere’s disease is characterized by specific symptoms. Together, they form what is known as the “triad of symptoms” and usually appear suddenly:
- acute rotational vertigo, which can also cause nausea and vomiting
- tinnitus, which occurs on one side and is characterized by a low-pitched ringing
- hearing loss accompanied by a sensation of pressure in the affected ear
However, only about one in five people with the condition experiences all three typical symptoms.
During an attack, rapid eye movements (nystagmus) also frequently occur. About 40% of those affected initially experience sudden hearing loss as the sole sign of their condition. The others predominantly exhibit balance problems.
The episode can last from minutes to hours and is often accompanied by nausea and vomiting. The tinnitus is usually unilateral and is often described as a low-pitched hissing or humming sound. Many also report ringing in the ear, a sensation of pressure, or a feeling of fullness in the affected ear. Hearing loss initially often affects the low-frequency range. For this reason, some people first notice that they have difficulty hearing low voices or low-pitched sounds.
In addition, fluctuations in hearing ability are among the symptoms. After an attack, hearing may initially improve, but as the disease progresses, it may remain increasingly impaired. This can lead to permanent hearing loss. In severe cases, the disease can result in complete hearing loss over time.
Diagnosis is based on the patient’s symptoms, medical history, and various tests.
Doctors can diagnose Meniere’s disease using various diagnostic procedures. These include, for example,
- audiometry,
- hearing tests,
- magnetic resonance imaging (MRI), or
- balance tests.
Audiometry is used to detect hearing loss in the mid- and low-frequency ranges. An MRI scan using contrast dye reveals endolymphatic hydrops. This helps confirm a diagnosis of Meniere’s disease.
Balance tests—medically known as neuro-otological tests—include, among others:
- Nystagmus testing to detect rapid eye movements during dizziness
- The Unterberger stepping test, in which patients are asked to step in place 50 times with their eyes closed; during this, they deviate up to 45° from their starting position
- Head impulse test, in which the patient is asked to fix their gaze on a fixed point, such as the doctor’s nose. The doctor will then quickly turn the patient’s head to the right and left and record the eye movements.
It is also important to rule out other conditions through differential diagnosis. What other conditions could cause these symptoms? In cases of uncertainty, doctors therefore conduct further tests to rule out, for example,
.
An MRI can help rule out other causes and, under certain conditions, visualize endolymphatic hydrops.
In Meniere’s disease, affected individuals experience episodic vertigo © Satjawat | AdobeStock
Both medication and surgical procedures are available for the treatment of Meniere’s disease. The latter are used only in severe cases, such as when medication is ineffective or insufficient.
Symptomatic treatment during an attack focuses primarily on bed rest and preventing falls. In addition, medications can be administered to counteract the effects of vertigo and associated nausea, such as antiemetics (e.g., gentamicin) and anti-vertigo drugs like betahistine. During an acute attack, patients should also avoid stimulants such as alcohol, coffee, or salty foods.
As a preventive measure, the doctor will prescribe medications designed to prevent future episodes of Meniere’s disease. These include, among others, medications that affect the body’s fluid balance, such as diuretics to increase fluid excretion through the kidneys.
Surgery aims to ventilate the middle ear. This involves inserting a small tube into the eardrum. In addition, there are surgical options to influence the function of the inner ear.
To address hearing loss, patients can be fitted with a hearing aid, which significantly improves their situation.
A saccotomy is a surgical procedure on the saccus endolymphaticus that can be performed in cases of severe symptoms of Meniere’s disease. It is intended to reduce fluid buildup in the middle ear and thereby alleviate recurrent episodes of vertigo.
The course of Meniere’s disease varies greatly from person to person.
In most cases, medication can reduce the number of vertigo attacks by 60–70% within 2–8 years.
However, hearing loss of up to 50 dB often occurs within the first 10 years of the disease. Hearing ability may also fluctuate. In rare cases, bilateral hearing loss may even occur.
Regular checkups are particularly important in the first few years after the onset of the disease. This allows doctors to determine whether the course of the disease is stabilizing or whether further measures are necessary.
Experts in Meniere’s disease can be found at ear, nose, and throat (ENT) practices or clinics. They are often specialists in vertigo.
Depending on the symptoms, however—particularly during the diagnostic phase—it may be necessary to consult neurologists and cardiologists as well. They can rule out causes of vertigo related to the nervous system or the cardiovascular system.
Is Meniere’s disease dangerous?
Meniere’s disease is generally not life-threatening. However, a sudden attack can be dangerous because those affected may fall or lose control while driving. Therefore, acute symptoms should be taken seriously and evaluated by a doctor.
What does a Meniere’s disease attack feel like?
An attack usually feels like severe rotational vertigo. Many people feel as though their surroundings are spinning. This may be accompanied by nausea, vomiting, tinnitus, pressure in the ear, and temporary hearing loss.
How long do vertigo attacks last in Meniere’s disease?
Vertigo attacks often last from 20 minutes to several hours. During this time, those affected are often unable to cope with physical or mental stress and must lie down. Exhaustion may follow.
Can Meniere’s disease go away?
Meniere’s disease is a chronic condition, but symptoms may subside over time. For many patients, the frequency of vertigo attacks decreases. However, hearing problems or tinnitus may persist.
What should you avoid if you have Meniere’s disease?
Those affected should be aware of their individual triggers. Stress, alcohol, nicotine, a very high-sodium diet, and lack of sleep are often perceived as aggravating factors. A strategy tailored by a doctor is more sensible than blanket prohibitions.
Which doctor treats Meniere’s disease?
The first point of contact is an ENT specialist. If symptoms are unclear, neurologists or cardiologists may also be consulted to rule out other causes of dizziness.
