What is Menierè's Disease?

Menierè's disease is a long-term progressive condition of the inner ear. The disease causes bouts - also known as episodes or attacks - of dizziness, tinnitus and hearing loss.

We don't know what causes Menierè's disease but there are a number of factors linked to why some people get it.

It can run in some families
People with increased pressure in the endolymphatic sac in the inner ear may be more likely to develop it.
Disturbances involving the balance of sodium and potassium in the fluid in the middle ear may lead to the disease.
People with an abnormal immune response - where the body has problems defending itself from alien bodies such as viruses - may develop the disease.
Some specific viral infections are linked to its development.
Stress can make the symptoms worse.
There is thought to be a strong relationship between migraine and Menierè's disease.
It may be associated with changes in blood supply to the ear.
It may also be associated with head injuries.

Menierè's disease is rarely a sign of a more serious condition but if you are at all concerned you should always discuss this with your GP.

What are the symptoms of Meniere's disease?

Menierè's disease has a range of symptoms. These are thought to be brought on by an increase in the volume of the fluid known as the endolymph, which is found in the inner ear.

If you have Menierè's disease you may have bouts of the condition separated by periods when you are not affected by it at all - known as remission. These may be as short as a few days or longer than ten years. These periods of remission vary in each person, and over time, which makes Menierè's disease an unpredictable and sometimes distressing illness.

The symptoms include:

Dizziness.
Nausea and vomiting, and occasionally diarrohoea, although these symptoms can get better with time.
Hearing loss, which tends to fluctuate in the early stages of the condition.
Occasionally, over-sensitivity to loud sounds. This is known as hyperacusis if your hearing remains normal, or recruitment, if you have a hearing loss.
Tinnitus - the word for noises that some people hear 'in the ears' or 'in the head' - buzzing, ringing, whistling, hissing and other sounds.
A blocked feeling in the affected ear.

When you first develop Menière's disease, the main symptom is bouts of dizziness. These bouts may also make you feel sick and in some cases you may actually be sick. If you get a spinning sensation, it is often very fast and is made worse if you move your head. These bouts can last from a few minutes to 24 hours.

During a bout, you may also notice a sensation of fullness and discomfort in the affected ear. You may also get hearing loss, before and during, the dizzy spells. You may also notice tinnitus or an increase of existing tinnitus in the affected ear. You may feel the fullness in your ear and/or have tinnitus prior to a dizzy bout, but you can often get bouts without warning. Between the bouts, your hearing, and the feeling of fullness in your ear, generally return to normal.

You may feel anxious, and have sweating and palpitations when you are having a bout. This can be made worse by the distress you feel at the time.

You might develop some hearing loss but usually only in the affected ear. You may not notice the hearing loss as at first it is usually mild. Initially the hearing loss may fluctuate and you may find your ability to hear lower pitches of sound will be affected first. Some people notice a hearing loss first of all and then develop dizziness later on.

As Menière's disease develops, the hair cells in the cochlea (in your inner ear) may become damaged, which will result in permanent hearing loss. This will usually only be in one ear unless you have developed the much less common problem of Menière's disease in both ears. The tinnitus may become more noticeable as the hearing loss gets worse, it can also fluctuate with the bouts of Menière's disease.

You might find that you are over sensitive to some sounds - hyperacusis. This may happen at, or around the time of, the bouts of dizziness. This over sensitivity is not always related to how loud the sound is. You may also get severe discomfort from loud sounds despite a hearing loss and this is then known as recruitment - this means you have difficulty hearing quiet sounds but are over sensitive to loud sounds.

You will probably get fewer bouts of dizziness as the disease develops and they may eventually disappear. However, some people still feel unsteady and dizzy if they move quickly, or more commonly at night when it is dark. You may also notice that you have difficulty focusing and reading but this can be helped by treatment.

Some people have severe bouts of Menière's disease, while others have milder bouts. After a bout, your hearing and tinnitus can improve again, and there may be long period when you have no symptoms at all.

How is Menière's disease diagnosed?

If you are concerned about any dizziness or balance problems you should visit your GP. If your GP thinks you have Menière's disease, you may be referred to the ear, nose and throat (ENT) or audiology department in your local hospital for further tests. In some parts of the country, you may also be referred to a specialist balance clinic.

Menière's disease usually first appears in people between the ages of 20 and 45 years. If you have your first bout of dizziness in your 70's, it is less likely to be Menière's disease.

Testing for Menière's disease

There is no specific test that is reliable for testing for Menière's disease. The specialist will use a series of tests to help diagnose it.

Balance tests

Your balance will probably be tested using the caloric test. This involves running water or puffing air, which in turn is slightly hotter, then colder, than your body temperature, into the ear canal. This alters the temperature in your inner ear fluids, making them move in one direction, or the other. Your eye movements then show how well the balance mechanism in each of your ears is working while this is going on. The test may make you feel a bit dizzy, and occasionally sick, but it is not unpleasant if done carefully, and it will not bring on a bout of Menière's disease.