Types of Brain Injuries: Ménière's Disease

What is Ménière's disease?

Ménière’s disease, also called idiopathicendolymphatic hydrops, is a disorder of the inner ear that affects hearing and balance. Ménière’s disease is one of the most common causes of dizziness originating in the inner ear. It also causes sudden attacks of vertigo (a spinning sensation), tinnitus (a loud ringing in the ears), and a temporary loss of hearing. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.

What causes Ménière's disease?

The cause of Ménière's disease is not known, but it is related to a fluid imbalance in the inner ear.

The inner ear contains a fluid called endolymph. It is thought that, in Ménière's disease, too much of this fluid builds up in the inner ear. The resulting pressure affects the sensory systems in the inner ear that help maintain balance. This leads to the symptoms of tinnitus (ringing in the ears), hearing loss, vertigo (spinning sensation), and pressure or fullness in the ear.

Little is known about the cause of endolymph fluid buildup. It may be that too much fluid is produced or that the fluid does not properly drain from the inner ear, or it may be a combination of the two.

What are the symptoms?

Symptoms of Ménière's disease are:

• Vertigo attacks that occur suddenly and last from several minutes to hours.
• The spinning sensation caued by vertigo is often severe enough to cause nausea and vomiting.
• A low-pitched roaring, ringing, or hissing sound in the ear (tinnitus).
• Hearing loss (often of low-frequency sounds) that may return to normal after the attack or may be permanent.
• A feeling of pressure or fullness in the ear.
• Vertigo is not the same as feeling dizzy.
• Dizziness is feeling unsteady or lightheaded, while vertigo is a sensation of whirling or spinning.
• Symptoms of dizziness and vertigo may be caused by many conditions other than Ménière's disease.

Sometimes you may sense that an attack is about to occur. The indication might be:

• An increasing feeling of pressure in the ear.
• Sounds seeming louder than normal.
• Nausea. A few people have nausea before an attack.

However, nausea can have many causes; it does not always mean an attack is about to occur.

How is Ménière's disease diagnosed?

Your health professional can usually diagnose Ménière's disease by taking your medical history and doing a physical exam.

If the cause of your vertigo is unclear, your health professional may want to do more tests to determine whether your symptoms are caused by problems in the inner ear or brain. Brain-related causes of symptoms (such as stroke, head injury, brain tumors, or multiple sclerosis) are less common.

Additional tests that may be done to rule out other causes of your symptoms and to confirm a diagnosis of Ménière's disease include:

• Electronystagmography, which uses electrodes to measure eye movements. It looks for characteristic eye movements that occur when the inner ear is stimulated. The pattern of eye movements can indicate the location of the cause of the vertigo, such as the inner ear or the central nervous system.
• Imaging tests, such as magnetic resonance imaging of the head (MRI) or computed tomography of the head (CT scan), which may be done if symptoms could be caused by a brain problem.
• Hearing tests, to detect hearing loss. A specific type of hearing test, called an auditory brain stem evoked potential (ABEP) study, may be done to determine whether the nerve from the inner ear to the brain is working correctly. Hearing loss supports a diagnosis of Ménière's disease.

How is it treated?

Although Ménière's disease cannot be cured, treatment is available to control symptoms and reduce the frequency of attacks. During an attack, medications may be used to reduce vertigo and control nausea and vomiting.

Unfortunately, no treatment is available to prevent the hearing loss that may eventually occur with progressive attacks of Ménière's disease.

Initial treatment

Early treatment of Ménière's disease focuses on controlling the symptoms-especially vertigo, a spinning sensation-and reducing the frequency of attacks. Changing your diet may reduce the number and frequency of future attacks.

Treatment most often used to reduce the frequency and severity of attacks of Ménière's disease includes:

• Taking medications such as diuretics to reduce the accumulation of fluid (endolymph) in the inner ears
• Avoiding caffeine, alcohol, tobacco, and stress or any substances or conditions that trigger an attack.
• Taking vestibular suppressant medications (such as antihistamines or sedatives) to calm the inner ear.
• Eting a low-sodium diet to reduce fluid build up in the inner ears.

Vertigo may be easier to tolerate if you lie down and hold your head very still until the attack passes. Antiemetic medications may be used to reduce vertigo and control nausea and vomiting.

Ongoing treatment

Ongoing treatment of Ménière's disease is aimed at controlling the symptoms and reducing the frequency and severity of attacks. Maintaining changes to your diet and lifestyle are important:

• Take diuretic medications to reduce the build up of inner ear fluid (endolymph).
• Avoid caffeine, alcohol, tobacco, and stress which can trigger an attack.
• Eat a low-sodium diet to reduce extra body fluid.

It is important to minimize the personal safety risks posed by Ménière's disease. For more information:

An episode of vertigo may be easier to tolerate if you lie down and hold your head very still. Medications such as antihistamines may be used to reduce vertigo. Antiemetic medications may be used to control nausea and vomiting from vertigo.

Treatment if the condition gets worse

It is important to minimize the personal safety risks posed by attacks of Ménière's disease.

An attack of vertigo may be easier to tolerate if you lie down and hold your head very still. Medications such as antihistamines may be used to reduce vertigo. Antiemetic medications may be used to control nausea and vomiting from vertigo.

If symptoms of Ménière's disease do not respond to treatment, surgery is an option. The goal of surgery is to eliminate the symptoms of Ménière's disease without destroying hearing in the affected ear.

In rare circumstances, severe, persistent vertigo caused by Ménière's disease may be treated by destroying the balance center in the inner ear (labyrinth) through surgery (labyrinthectomy) or with an antibiotic injected into the ear (chemical ablation) to destroy the labyrinth. Since these treatments usually cause deafness in that ear, they are generally used only as a last resort.

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