Meniere's Disease (Inner Ear Problem)
Symptoms of Meniere’s disease include:
- Vertigo (attacks can last anywhere from a few minutes to 24 hours)
- Loss of hearing in the affected ear
- Tinnitus (a sensation of ringing) in the affected ear
- A feeling of fullness in the affected ear
- Loss of balance
- Nausea, vomiting, and sweating caused by severe vertigo
If you are experiencing symptoms of Meniere’s disease, your doctor will order tests to examine your balance and hearing and to rule out other causes of your symptoms.
A hearing test is used to determine if you are experiencing hearing loss. This test is also called audiometry. In this test, you will put on headphones. You will hear noises with a variety of pitches and volumes. You will need to indicate when you can and cannot hear a tone, so the technician can determine if you are experiencing hearing loss.
Your hearing will also be tested to determine if you can differentiate between similar sounds. In this portion of the test, you will hear words through the headphones. You will need to repeat what you hear. The results of this test will tell your doctor if you have a hearing problem in one or both ears.
Hearing loss can be either caused by a problem in the inner ear or by a problem with the nerve in the ear. Electrocochleography (ECog) is a test done to measure the electrical activity in the inner ear. Auditory brainstem response audiometry tests the function of the hearing nerves and the hearing center in the brain. These tests can tell your doctor if the problem is caused by your inner ear or with your ear nerve.
Balance tests are done to test the function of your inner ear. People who have Meniere’s disease will have a reduced balance response in one of their ears. The balance test most commonly used to test for Meniere’s disease is electronystagmography (ENG).
In this test, you will either have electrodes placed around your eyes to detect eye movement. This is because the balance response in the inner ear causes eye movements.
During this test, both hot and cold water will be pushed into the ear. The water causes the balance function to work. Your involuntary eye movements will be tracked. Abnormalities indicate a problem with the inner ear.
Other, less common balance tests include rotary chair testing, vestibular evoked myogenic potentials (VEMP) testing, and posturography.
Rotary chair (also called rotational chair or rotatory chair) testing will show your doctor whether your problem is caused by a problem in your ear or your brain. It is used in addition to ENG testing because the ENG results can be incorrect if there is wax blocking one of your ear’s canals or if your ear is damaged. In this test, the chair is moved while your eye movements are carefully recorded.
VEMP testing measures the sound sensitivity of the vestibule of the inner ear.
Posturography testing helps determine which part of your balance system is not functioning properly. Wearing a safety harness and standing bare feet on a platform, you will react to various balance challenges.
Issues with the brain, such as multiple sclerosis or brain tumor, can cause symptoms similar to Meniere’s disease. Your doctor may order tests to rule out other problems. Your doctor may order a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan to assess possible problems with your brain.
Ménière’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.
The most disabling symptom of an attack of Ménière’s disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.
Salt restriction and diuretics
Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
Other dietary and behavioral changes
Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.
Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.
Pressure pulse treatment
The U.S. Food and Drug Administration (FDA) recently approved a device for Ménière’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness.
Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.
Although scientists have studied the use of some alternative medical therapies in Ménière’s disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as gingko biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies, since they sometimes can impact the effectiveness or safety of conventional medicines.