One of the most common causes of dizziness originating in the inner ear is Ménière’s disease. It is a condition that causes vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear.
Ménière’s disease results in episodic symptoms of vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours. Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves lower pitches, but over time this often affects tones of all pitches. After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.
Ménière’s disease is also called idiopathic endolymphatic hydrops and is one of the most common causes of dizziness originating in the inner ear. 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. Because Ménière’s disease affects each person differently, your doctor will suggest strategies to help reduce your symptoms and will help you choose the treatment that is best for you.
Although the exact cause is unknown, Ménière’s disease is thought to result from an abnormality in the volume of fluid in the inner ear. The fluid may accumulate due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Ménière’s disease. Other conditions may mimic the symptoms of Ménière’s disease, so a complete evaluation is necessary.
Your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:
- For hearing: An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear.
- For balance: An ENG (electronystagmogram) may be performed to evaluate balance function. In a darkened room, eye movements are recorded as warm and cool air are gently introduced into each ear canal. Since the eyes and ears work in coordination through the nervous system, measurement of eye movements can be used to test the balance system. Often the balance function is reduced in the affected ear.
- Other tests: Electrocochleography (ECoG) is a painless test of inner ear pressure that is somewhat indicative of Ménière’s disease.
Magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière’s disease.
Although there is no cure for Ménière’s disease, the attacks of vertigo can be controlled in nearly all cases. Preventative measures include avoiding stress, excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Medications such as a diuretic (water pill) or anti-vertigo medication may be prescribed. Further treatments with intratympanic injection with gentamicin or dexamethasone may be needed, and in some cases surgery may be required.
Salt Reduction: A common way to combat Ménière’s is to eat less salt. Salt contains sodium, which makes your body hold excess fluid. Because Ménière’s is thought to be due to fluid buildup in the inner ear, eating less sodium may help relieve your symptoms. A common recommendation is to limit sodium to no more than 1500 mg each day. In many people, careful control of salt in the diet and the use of diuretics can control symptoms satisfactorily.
Avoid Certain Substances: Certain substances affect how your body regulates fluid and can make Ménière’s worse. These include: caffeine, which causes significant fluctuations in your bodily fluid status; and alcohol, which can disturb your sense of balance and should be limited to very small amounts.
Smoking, which constricts blood vessels, weakens your immune system, and harms your general health, may also contribute to Ménière’s symptoms. Quitting smoking is always recommended.
During an attack, the best advice is to lie flat and still and focus on an unmoving object. Often people fall asleep while lying down and feel better when they awaken.
Intratympanic injections involve injecting medication through the eardrum into the middle ear space where the ear bones reside. This treatment is done in the otologist’s office on an outpatient basis. The eardrum can be anesthetized with a simple medication making the procedure almost painless. The drug may be administered once or several times. Medication injected may include steroids or gentamicin. Steroids do not cause worsening of hearing loss and may calm down the overactive ear. Gentamicin alleviates dizziness but also carries the possibility of increased hearing loss in the treated ear.
The expert physicians at the Midwest Ear Institute can help you choose the treatment that is best for you, as each has advantages and drawbacks.
Surgery is needed in only a small minority of patients with Ménière’s disease. If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:
Endolymphatic sac shunt or decompression procedure relieves attacks of vertigo in one-half to two-thirds of cases and the sensation of ear fullness is often improved. Control can be temporary, but often offers improvement for years. Endolymphatic sac surgery does not improve hearing, but only has a small risk of worsening it. Recovery time after this procedure is short compared to the other procedures.
Vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. While vertigo attacks are permanently cured in a high percentage of cases, patients may continue to experience imbalance. Similar to endolymphatic sac procedures, hearing function is usually preserved.
Labyrinthectomy is a procedure in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Ménière’s disease has poor hearing in the affected ear. Labyrinthectomy results in the highest rates for control of vertigo attacks.