Meniere’s Disease

Researchers don't know why the fluid builds up in your inner ear, but their most common theories suggest that something has disrupted how your body balances making and breaking down endolymph in your ear. This could be because of:

• Allergic reactions or autoimmune conditions (when your immune system mistakenly attacks your body tissues)
• Viral infections
• Genetic factors
• Narrowing of blood vessels (similar to what happens with migraine headaches)

Most researchers think that several of these issues come together to cause Meniere’s disease.

Meniere's Disease Risk Factors

You may have a higher risk of getting Meniere's disease if:

• You have an autoimmune condition, especially rheumatoid arthritis, systemic lupus erythematosus, or ankylosing spondylitis
• Someone in your family has the condition (about 7%-10% of people with Meniere's disease have a family history)
• You're 40-60 years old
• You're assigned female at birth (AFAB)

Meniere’s Disease Symptoms

Symptoms usually include:

• Hearing loss, which may get worse over time.
• Episodes of sudden dizziness or vertigo that last 20 minutes to 24 hours. You usually won't faint or pass out, but you may have abnormal eye movements, making you feel like the room is spinning. Nausea or vomiting may follow. Some people may have “drop attacks,” which is when you fall on the ground because you are so dizzy.
• Ringing in your ears (tinnitus), which may get worse right before a vertigo episode and go away afterward.
• A feeling of fullness or pressure in your ear.

Any of your symptoms may come and go, or get worse and then better.

Meniere’s is a progressive disease, which means it tends to get worse over time. It may start slowly with occasional hearing loss. Vertigo may develop later. Attacks can last 20 minutes or as long as 24 hours. You might get several in a week, or they might come months or even years apart. Afterward, you may feel tired and need to rest.

Along with the main symptoms, some people may have anxiety, as they may worry too much about when and how a sudden vertigo attack will affect them. Some people also get depression due to the main symptoms, which can make it difficult for them to live their day-to-day lives.

Your doctor may describe the symptoms in three stages:

• Stage I (early stage). In this stage, you may have unpredictable attacks of vertigo. You will have some amount of hearing loss and a feeling of fullness during these attacks. Sometimes, you may get ringing in your affected ear right before the attack, and they usually happen without warning. In between your attacks, your hearing and feeling of fullness may go back to usual.

• Stage II (intermediate stage). In this stage, you will likely still get vertigo attacks, but they may not be as bad. After the vertigo attack and sometimes before, you may feel unbalanced or giddy when you move around. You may get some permanent hearing loss that worsens during vertigo attacks. Ringing in your ear may get worse and increase during a vertigo attack.

• Stage III (late stage). In this stage, your vertigo attacks may stop or go away, but your hearing loss may get worse. At this point, you likely have permanent damage to the balance organs in your inner ear. You may also have trouble keeping your balance, especially in the dark.

Meniere’s Disease ​​​​​​​Diagnosis

Meniere's disease is very rare, although the main symptoms are fairly common. To be diagnosed with it, you need to have:

• Two or more vertigo attacks
• Hearing loss confirmed by a hearing test
• Tinnitus or a feeling of fullness or pressure in the ear

Your doctor will examine your ears and ask you questions to help rule out other potential causes of your symptoms.

To help figure out what's causing your symptoms, your doctor may use a few different tests:

Hearing tests (audiometry). Audiometry tests how well you can hear sounds at different pitches and volumes and how well you can distinguish words that sound the same. For instance, your ability to tell the difference between words such as “fit” and “sit.” People with Meniere's disease may have hearing loss at both high and low frequencies, although their hearing may be fine in the middle frequencies.

Balance tests (vestibular test battery) to see how well your inner ear is working, such as:

• Electronystagmography (ENG) or videonystagmography (VNG). These tests assess your balance. You will sit in a darkened room, and your doctor will measure your eye movements as you follow a target, move your head, and feel cool and warm air blowing into your ear canal.
• Rotary chair testing. You sit in a computer-controlled chair that spins to trigger your inner ear, then your doctor will track your eye movements.
• Vestibular evoked myogenic potential (VEMP). This measures how well the muscles in your inner ear react to sounds.
• Computerized dynamic posturography (CDP). This tests how well you can keep your balance under different conditions. You stand barefoot on a platform that can move in several directions. You wear a safety harness and your doctor watches how you respond when the platform moves.
• Video head impulse test (vHIT). This uses video images to see how well you can focus on a point when your head is moved suddenly.
• Electrocochleography. This measures the fluid pressure in your inner ear.

To help rule out other conditions, your doctor may do a few other tests, such as:

• Lab tests
• Imaging scans, such as CT or MRI scans with contrast

Meniere’s Disease Treatments

No treatment can cure Meniere's disease, but your symptoms may get better with treatment. Your doctor will likely start with noninvasive treatments with the fewest side effects first and then proceed to more invasive treatments if you still have symptoms. 

Your doctor may suggest any of the following:

Lifestyle changes. A diet that cuts down on your sodium may help prevent vertigo attacks because it helps lower the fluid volume and pressure in your inner ear. Also, try to avoid red wine, bananas, chocolate, caffeine, yogurt, nuts, smoked meats, candy, jelly, soda, and sugar substitutes such as aspartame. Make sure to drink plenty of water every day, and eat a healthy diet with lots of fresh fruits and vegetables, especially dark, leafy greens.

Medicines for vertigo. Vertigo is probably the most serious symptom of Meniere's disease because it can interrupt your daily life and put you in danger of injury from falling. So, your doctor will usually treat this symptom with medicine to treat dizziness or vertigo, such as:

• Anti-nausea medicines, such as hyoscine (Scopolamine), ondansetron (Zofran), and prochlorperazine (Compazine)
• Anti-vertigo medicines, such as betahistine (Serc)
• Diuretic medicines (water pills) to decrease your inner ear fluid volume, such as hydrochlorothiazide (Dyazide) and triamterene
• Motion sickness medicines, such as diazepam (Valium), meclizine (Antivert), and lorazepam (Ativan)

Surgery. If you have tried other treatments and they haven't helped, your doctor may recommend surgery options, such as:

• Labyrinthectomy. Your surgeon destroys the parts of the ear that control balance. You aren’t awake during this procedure, and you stay in the hospital for a few days. You will have hearing loss afterward, so it’s for people who have really bad vertigo and don’t hear well.
• Vestibular nerve section. A neurosurgeon does this procedure, and you'll likely need a hospital stay of up to 5 days. Your surgeon will destroy the nerve that sends signals about balance to your brain to stop the messages that are causing your vertigo.
• Endolymphatic sac decompression. A surgeon opens and drains the part of your ear responsible for reabsorbing fluid. You’ll be given anesthesia so that you won’t be awake or feel pain during the operation. You will probably spend the night in the hospital.

Alternative therapies. Some people find that acupuncture, acupressure, or tai chi can ease their symptoms. Some supplements may also help by boosting your immune system or blood circulation. These include:

• Manganese, magnesium, calcium
• Vitamins B (especially B3 or niacin) and C
• Omega-3 fatty acids (especially alpha lipoic acid, or ALA) and lipase enzyme
• Gingko biloba, ginger root, cayenne pepper
• Colloidal silver

Before you try any alternative therapies, talk to your doctor because some can affect your other treatments.

Meniere’s Disease Home Treatments

Here are some self-care tips that may help you avoid a vertigo attack:

When you feel dizzy:

• Sit or lie down and stay still.
• Don’t make sudden movements, and avoid bright light, loud noise, and other triggers. Watching TV or even reading can trigger attacks.
• Focus your eyes on something that's not moving.

Rest during and after attacks. Don't rush to get back to your day-to-day activities. Allow yourself to slowly get up and move around when you feel better to help your brain adjust the signals from your inner ear.

Prepare yourself before it happens. Talk to your doctor about what you should do when you get an attack. For instance, talk to your doctor about medicines for dizziness and ask how you can prevent falls and injuries.

Several things can trigger vertigo attacks. If you know what triggers your attacks, you can try to avoid them. Try to write down as many things as you can remember about your episodes. Your triggers may include:

• Moving around, especially quickly. For instance, standing up too quickly can set off a vertigo attack. Turning or tilting your head (especially if you tilt it backward) can also set off your vertigo.
• Bending over. Bend at your knees if you need to pick something up off the ground instead of just reaching downward. Consider using a hand-held shower head for rinsing your head so you won't need to bend over or tilt your head backward.
• The weather, intense light, and strong smells.
• Exposure to tobacco smoke, recreational drug use, stress, anxiety, and processed foods.

Meniere's Disease Prevention

It’s not clear you can do anything to prevent Meniere’s disease because it often starts suddenly and you may not know what caused it.

If you have family members with Meniere's disease, talk to your doctor about adding screening for Meniere's disease into your annual physical exam because you may have a higher risk of getting it than other people.

If you have sudden dizzy spells, see your doctor.

Meniere's Disease Diet

Experts recommend you avoid the following foods:

Foods high in sodium or carbohydrates. Salt and carbohydrates can make you retain water, which may increase the pressure in your inner ear and trigger a vertigo attack. Avoid canned and other processed foods, which tend to have a lot of sodium. Also avoid foods high in refined carbohydrates, such as rolls, bread, pancake mix, salted crackers, and pasta. Limit your sodium to less than 1,500 milligrams per day. Especially avoid things such as:

• Soy sauce
• Bottled salad dressing
• Ketchup
• Salted butter
• Buttermilk
• Processed cheese
• Smoke, salted, and cured meat
• Hot dogs
• Anchovies
• Candy (including chocolate)
• High-fructose corn syrup
• Honey
• Jams and jellies
• Foods high in a sugar called galactose, which is in sweetened yogurt, cherries, kiwifruit, plums, and avocados
• Foods high in a sugar called maltose, which is in wheat, corn, barley, and rye

Caffeine and alcohol. Both can trigger migraine and vertigo attacks.

Foods high in an amino acid called tyramine. This amino acid can trigger migraines, which may set off a vertigo attack. Foods that have high levels of tyramine include:

• Bananas
• Brie and cheddar cheese
• Chicken livers
• Chocolate
• Figs
• Nuts
• Red wine
• Smoked meats
• Yogurt

Monosodium glutamate (MSG). This is a bit controversial because some dieticians may recommend you replace salt with MSG. However, some people are sensitive to it, so if you eat it, pay attention to how you respond. MSG is often found in: 

• Plant protein extracts
• Yeast extracts
• Textured protein
• Soy or whey protein concentrate
• Corn oil
• Malt extract or flavoring
• Broth or stock
• Beef or chicken flavoring

Experts recommend that you add foods high in potassium to your diet. Foods high in potassium can help you reduce the amount of fluid built up in your body. Try substituting foods high in sodium for foods high in potassium, such as baked potatoes, spinach, squash, tomatoes, and beans.

Other foods and drinks that can help you reduce fluid buildup include dandelion tea, hibiscus, ginger, nettle, beets, asparagus, and celery.

Meniere's Disease and Driving

In most cases, you must tell your driver's licensing agency and the company that insures your car that you have Meniere's disease. If you haven't shared this information with them, you could be charged a fine or lose your insurance in the event of an accident.

In the U.S., if you are at risk of getting sudden vertigo attacks, the National Highway Traffic Safety Administration recommends you avoid driving until your symptoms are gone or under control. Most people with Meniere's disease have enough warning of a vertigo attack that they can avoid driving when they aren't feeling well. But, you must avoid driving if you have drop attacks.

When you're in a car, bus, or train, keep your medicine and sealable plastic bags with you in case you feel dizzy or nauseated. If you're on a bus or train, sit down if you can. Keeping your balance when the vehicle starts and stops can be challenging. Keep your eyes facing front and avoid watching the world flash by because that flicker of movement can trigger a vertigo attack.

Takeaways

Meniere’s disease is an inner ear condition that can cause vertigo (dizziness that can feel like the room is spinning), tinnitus (ringing in your ear), and hearing loss. Researchers don't know why some people get it and others don't. But you are more likely to get it if anyone in your family has it, you have an autoimmune condition, you're assigned female at birth (AFAB), or you're between 40 and 60 years old. Unfortunately, there's no cure for Meniere's disease, but treatment can help with your symptoms. The most troublesome symptom is usually vertigo, but your doctor can give you medicines to help. If these don't work, there are several other treatments your doctor can try.

Meniere's Disease FAQs

What is the life expectancy of someone with Meniere's disease?

Meniere's disease isn’t a life-threatening condition. This means that it doesn't shorten your life expectancy. However, it can impact your quality of life. Getting treatment can help you live your best life although you may still get vertigo every once in a while.

What worsens Meniere's disease?

Doctors often recommend you cut down or avoid salt, caffeine, and alcohol. These are some of the main things in your everyday life that can set off a vertigo attack.