The Ménière's Society
Ménière’s disease is a disease of the
inner ear. The inner ear is composed of the organ of balance
(semicircular canals) and the organ of hearing (the cochlea).
Ménière’s disease (MD) is a long term,
progressive disease which damages both the balance and hearing
parts of the inner ear. The main symptoms of the disease
are vertigo, tinnitus and hearing loss.
It affects mainly white people. The incidence is between
1 per 1,000 and 1 per 20,000 of the population, depending
on the source of information quoted. It affects both sexes
equally. It can occur at all ages, including childhood,
and most frequently starts between ages of 20 and 50 years.
About 7-10% have a family history of the disease.
Initially the disease usually affects one ear, but 15%
of people have both ears affected at the start of symptoms.
As the disease progresses, up to 50% will develop the disease
in both ears.
WHAT ARE THE CAUSES OF MENIERE'S DISEASE?
The cause is unknown. Many factors are probably involved
in the development of the disease. The relationships between
these factors and the progression of the disease remain
unclear. The factors that may be involved are:
- Increased pressure of the fluid in the endolymphatic
sac in the inner ear.
- A familial predisposition to develop the disease.
- Allergic factors damaging the inner ear.
- Some specific viral infections.
- Vascular factors. There is an association between migraine
and Ménière’s disease.
- Metabolic disturbances involving the balance of sodium
(Na+) and potassium (K+) in the fluid of the inner ear.
- Unknown factors.
HOW DOES THE DISEASE AFFECT YOU?
MD is a fluctuating progressive illness and the symptoms
vary between people, and with time in the individual person.
It is useful to divide the course of the illness into 3
stages.
Stage 1: Early
The main feature is intermittent attacks of vertigo (giddiness)
associated with nausea and vomiting. These attacks can last
from a few minutes to 24 hours. During the attack there
is a variable amount of hearing loss, and a sensation of
fullness and discomfort in the affected ear. There may be
tinnitus (noises in the ear) or an increase in existing
tinnitus in the ear. The fullness in the ear and the tinnitus
may precede the attacks of vertigo, but often they occur
without warning. Between attacks the hearing and sensation
in the ear return to normal. The attacks vary in severity
and length. There can be giddiness lasting a few minutes
to severe rotational vertigo with vomiting, causing the
person to lie completely still for several hours. There
are periods of remission between the attacks, which can
vary from days to months or even years. The periods of remission
vary in each person and with time, making MD an unpredictable
and distressing illness.
MAIN PROBLEM(S): Unpredictable attacks of vertigo
Stage 2: Intermediate
The attacks of vertigo continue, with variable remissions.
They may be less severe. The attacks may be preceded or
be followed by a period of imbalance and movement induced
giddiness, adding to the distress. Permanent hearing loss
develops and continues to fluctuate with the vertigo attacks.
Tinnitus becomes more prominent; it also fluctuates, increasing
with the attacks.
MAIN PROBLEM(S): Attacks of vertigo, tinnitus, hearing loss
Stage 3: Late
In the later stages the hearing loss increases and often
the attacks of vertigo diminish or stop. The disease affects
both ears in up to 50% of people. Hearing loss can be severe
and distortion, loudness discomfort and recruitment a problem.
There is permanent damage to the balance organ in the ear
and significant general balance problems are common, especially
in the dark.
MAIN PROBLEM(S): Hearing loss, balance difficulties, tinnitus.
Associated Problems
During severe attacks of vertigo, many people also suffer
from diarrhoea, palpitations and sweating.
MD can severely affect the quality of life of the person.
It can affect ability to work and travel. Families and relationships
may suffer. Periods of depression and anxiety are common.
WHAT INVESTIGATIONS ARE NECESSARY TO MAKE THE DIAGNOSIS?
There is no specific test that, on its own, is reliable
in diagnosing MD. Your General Practitioner and Ear Nose
and Throat specialist will arrange appropriate investigations.
The history and progression of the illness together with
simple hearing (audiogram) and balance tests (caloric test)
will be sufficient in many cases. However, the three main
symptoms of vertigo, hearing loss and tinnitus occur in
many other illnesses, and these may need to be excluded
by tests (blood tests and MRI scan) before a final diagnosis
can be made. Other investigations may help with the management
and assessment of symptoms (postulography, electronystagmography,
speech audiogram).
WHAT TREATMENT IS THERE?
Treatment is aimed at reducing, controlling and helping
the symptoms. It is symptomatic treatment and will vary
with the needs of each patient at that time.
Treatments Aimed At Controlling The Attacks Of
Vertigo
Drugs such as betahistine (Serc) and a low dose of a diuretic
on a regular basis can reduce the frequency of attacks of
vertigo. Vestibular sedatives (cinnarizine-Stugeron) and
anti sickness drugs (prochlorperazine-Stemetil) help to
control the vertigo and vomiting during the attacks.
Specific Exercises
Vestibular rehabilitation exercises can be helpful between
the attacks of vertigo to help compensate for difficulties
with balance. The exercises can be especially useful in
later stages of the disease. These specific exercise programmes
need to be done only under the supervision of a physiotherapist
or hearing therapist.
Low Salt Diet
This can reduce the frequency and severity of attacks of
vertigo in some people.
Treatment To Help Tinnitus
Various white noise generators, which help mask the tinnitus,
as well as retraining and counselling are available.
Treatment To Help Hearing Loss
Hearing aids are important for all people with hearing loss,
whether it is in one ear (unilateral) or both ears (bilateral).
There are specific hearing problems for people with MD but
most can be helped by the range of aids available.
Adaptation Of Lifestyle
Reducing stress and regular relaxation helps with coping
with the anxiety MD can produce. Some complementary therapies
are beneficial.
Counselling
MD affects all aspects of a person’s life. Change
of employment, financial problems, as well as personal and
relationship difficulties can occur. Counselling can help
with these and improve the quality of life.
In 4 out of 5 people these measures are sufficient to control
the symptoms.
However if vertigo remains a problem there are several further
procedures that can help to control vertigo. These are:
Gentamicin Treatment
Controlled use of gentamicin given locally to the ear can
reduce and control the vertigo.
Saccus Decompression
This is a surgical operation on the endolymphatic sac of
the inner ear. There are several variations. They aim to
reduce the pressure of the fluid in the sac.
Vestibular Nerve Section
This is a neurosurgical operation. The nerve from the balance
organ in the inner ear is cut, stopping the abnormal messages
reaching the brain and therefore stopping the vertigo.
Labyrinthectomy
This operation destroys the inner ear and stops any vertigo
arising from that ear. However, it also destroys the hearing
in that ear.
WHAT CAN YOU DO TO HELP YOURSELF
Most people with MD cope well with their symptoms and the
problems it produces. Understanding the disease and discussing
treatment options with your doctor is valuable. Counselling,
relaxation and stress management play an important part
in maintaining a good quality of life. Contact with other
people with MD via local groups and the Ménière’s
Society can improve confidence and provide valuable support
and information. The Society can also support the family
and carers of people with MD.
The Ménière’s Society has many more
information sheets on all aspects of Ménière’s
disease, its treatment and management. Information sheets
and SPIN, the Society’s quarterly newsletter for members,
are available on joining the Society.
If you or a family member wish to join The Ménière’s
Society, please contact the address below for a membership
form and further details
The Ménière's Society
98 Maybury Road
Woking
Surrey
GU21 5HX
The Ménière's Society recommends that you
always consult your GP, Consultant or Therapist for professional
guidance before you change, temporarily suspend or discontinue
any treatment, medication, exercise or diet. The Society
cannot advise on individual cases nor accept any liability
resulting from the use of any treatments referred to in
this information sheet.
The Ménière's Society
98 Maybury Road
Woking
Surrey
GU21 5HX
United Kingdom
Tel: 01483 740597
Minicom: 01483) 771207
Fax: 01483 755441
Website: www.menieres.org.uk
Email: info@menieres.co.uk
The Ménière's Society is a registered charity
giving information and support to those with Ménière's
disease, and to their carers. We provide a helpline; information
sheets covering all aspects of understanding, treating and
living with Ménière’s disease; a quarterly
magazine; a Contact List; and encourage the formation of
self-help groups. We also support much needed research.
The Ménière’s Society
98 Maybury Road
Woking
Surrey
GU21 5HX
Tel: 01483 740597
Fax: 01483 755441
Minicom: 01483 771207
Registered Charity No 297246
