Menière’s disease refers to a condition of the inner ear where endolymphatic fluid builds up, leading to swelling in the in the organs responsible for hearing and balance. The cause of Menière’s disease is unknown but believed to be due to a combination genetic and environmental factors. It is not a common disease, and believed to affect 8.2 to 157 per 100,000 individuals per year [Espinosa-Sanchez, 2016].

Diagnosis

In 2015, the International Classification for Vestibular Disorders Committee of the Barany Society collaborated with the American Academy of Otolaryngology, the European Academy of Otology & Neuro-Otology, the Japan Society for Equilibrium Research, and the Korean Balance Society to publish the latest diagnostic criteria for Menière’s Disease [Lopez-Escamez, 2015]:

Definite Menière’s Disease

  1. Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
  2. Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least 1 occasion before, during, or after one of the episodes of vertigo
  3. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
  4. Not better accounted for by another vestibular diagnosis

Probable Menière’s Disease

  1. Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours
  2. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the reported ear
  3. Not better accounted for by another vestibular diagnosis

The attacks of Meniere’s disease are typically characterized by one-sided ear pressure or fullness, muffled hearing, and a low-pitched rumbling or roaring tinnitus followed by vertigo. These vertigo attacks last between 20 minutes to 12 hours [Espinosa-Sanchez, 2016]. It is important to note that this classic triad of vertigo, tinnitus, and hearing loss only occurs in 40% of patients [Belinchon, 2012]; it is not uncommon for episodic vertigo without aural symptoms in the first year [Pyykko, 2013]. Audiometry is important to identify asymmetric low-frequency hearing loss, or fluctuating hearing loss – vital clues to making the diagnosis.

Menière’s Disease, Migraine & Vestibular Migraine

Menière’s disease and vestibular migraine share similar symptoms, and can often overlap, leading to much confusion. Complicating matters, there is a higher prevalence of migraine among Menière’s disease patients (about one-third) [Shin, 2013]. Furthermore, migraines may be provoked by Menière’s disease attacks, resulting in episodes of vertigo accompanied by migraine symptoms. It is important to be evaluated by a neurologist and otolaryngologist to help distinguish the two entities since the treatment for each is different.

Treatment

Non-pharmacologic measures like reducing salt intake, and eliminating foods like chocolate, alcohol, and caffeine, should be undertaken by people with Menière’s disease. Salty foods in particular can trigger Menière’s disease attacks.

Medications like diuretics (which help the body get rid of excess salt) and betahistine (which improves inner ear blood flow) can also help. Diuretics can cause electrolyte imbalances, and should only be used under a physician’s supervision. Betahistine has to be prepared by compounding pharmacies, and may not be covered by insurance.

Intratympanic corticosteroid injections can be useful in those who do not respond to these medications. Intratympanic gentamicin to destroy the inner ear, and eliminate the source of vertigo, can be considered in some patients. Surgical procedures like endolymphatic sac decompression, labyrinthectomy, or vestibular nerve section are more invasive, and need to be carefully discussed with neuro-otologists.


References

Belinchon A, Perez-Garrigues H, Tenias JM, et al. Evolution of symptoms in Meniere’s disease. Audiol Neurootol 2012;17:126-132

Espinosa-Sanchez JM, Lopez-Escamez JA. Menière’s disease. Handb Clin Neurol 2016;137:257–77

Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière’s disease. J Vestib Res 2015;25: 1–7

Pyykko I, Nakashima T, Yoshida T, Zou J, Naganawa S. Meniere’s disease: a reappraisal supported by a variable latency of symptoms and the MRI visualization of endolymphatic hydrops. BMJ Open 2013;3:e001555

Shin JE, Kim CH, Park HJ. Vestibular abnormality in patients with Meniere’s disease and migrainous vertigo. Acta Otolaryngol 2013;133:154-158