Meniere's disease: information and specialists

Meniere's disease is also known as paroxysmal vertigo. This means that those affected suffer from attacks of dizziness that can last for minutes or hours. During this time, sufferers tend to lose their balance and fall down.

In this article, you can find out more about the condition and which specialists treat Menère's disease.

How common is Meniere's disease?

Meniere's disease mainly occurs between the ages of 40 and 50. Women are affected more frequently than men. Around 13 out of 100,000 people in Central Europe are newly diagnosed with Meniere's disease every year.

Meniere's disease can also be associated with other illnesses. In such cases, medicine speaks of comorbidities. Migraine or rheumatoid arthritis are the most common.

What are the causes of Meniere's disease?

The exact causes of the seizure-like rotary vertigo are still largely unknown.

The trigger is usually an endolymphatic hydrops (increased formation of endolymph) in combination with a disturbed inner ear homeostasis.

This means that there is a change in the pressure conditions of the lymph in the inner ear. This damages the sensitive membranes in the inner ear. This causes uncontrolled lymph leakage, which the brain misinterprets as a change in the body's position. This causes the feeling of dizziness.

The spontaneous adhesion of the ruptured membranes then finally ends the vertigo attack.

In around 7-15% of cases, there are also hereditary causes . In children with Meniere's disease, there are often other cases in the family (= positive family history).

What symptoms indicate Meniere's disease?

Meniere's disease includes characteristic symptoms. Together they form a so-called symptom triad:

• acute rotary vertigo, which can also cause nausea and vomiting
• Tinnitus, which occurs on one side and with a low-pitched noise
• Hearing loss, which is accompanied by a feeling of pressure in the affected ear

However, only around one in five of those affected suffer from all three typical symptoms.

During an attack, rapid eye movements (eye tremors, nystagmus) are also common. Around 40% of those affected initially suffer from hearing loss as the only sign of their illness. The others mainly experience balance problems.

Diagnosis of Meniere's disease

Doctors can diagnose Meniere's disease using various diagnostic procedures. These include, for example

• audiometry,
• magnetic resonance imaging(MRI) or
• balance tests.

Audiometry is used to determine hearing loss in the medium and low frequency range. The MRI examination shows the endolymph hydrops under contrast medium. This allows the diagnosis of Menière's disease to be confirmed.

The balance tests - medically known as neuro-otological tests - include

• Nystagmus test to detect rapid eye movements in dizziness
• Unterberger tread test, in which patients are asked to step on the spot 50 times with their eyes closed, deviating up to 45° from the starting position
• Head impulse test, in which the patient is asked to fixate on a fixed point with their eyes, e.g. the doctor's nose. The doctor will then quickly turn the patient's head to the right and left and document the eye movement.

It is also important to clarify the differential diagnosis of the symptoms of Meniere's disease. So what other illness could be causing these symptoms? In case of doubt, doctors therefore carry out further examinations, for example to

• a benign paroxysmal positional vertigo,
• a vestibular migraine or
• neuropathia vestibularis

can be ruled out.

In Meniere's disease, sufferers experience dizziness in attacks © Satjawat | AdobeStock

How is Meniere's disease treated?

Medication and surgical procedures are available for the treatment of Meniere's disease. The latter are only used in severe cases of the disease, e.g. if medication does not help or does not help sufficiently.

Symptomatic therapy during an attack is based in particular on bed rest and avoiding falls. In addition, medication against the effects of dizziness and associated nausea, so-called antiemetics and antivertiginous drugs, can be given. Those affected should also avoid stimulants such as alcohol, coffee or salty foods during an acute attack.

As a prophylactic measure, the doctor will prescribe medication to prevent future attacks of Meniere's disease. This includes medication that affects the body's water balance, such as diuretics to increase water excretion via the kidneys.

The aim of an operation is to ventilate the middle ear area. This involves inserting a small tube into the eardrum. There are also options for surgically influencing the function of the inner ear.

Patients can be fitted with a hearing aid to counteract the hearing loss so that the situation improves significantly.

What is the prognosis for Meniere's disease?

In most cases, the number of vertigo attacks can be reduced by 60-70% within 2-8 years with medication.

However, hearing loss of up to 50 dB often occurs in the first 10 years of the disease. The hearing performance can also fluctuate. In rare cases, hearing loss can even occur on both sides.

Which doctors treat Meniere's disease?

Experts for Meniere's disease can be found in ear, nose and throat practices or clinics. These are often specialized vertigo specialists.

However, depending on the symptoms, it may also be necessary to involve neurologists and cardiologists in the diagnosis. They can rule out causes in the area of the nerves and the cardiovascular system for the dizziness.