The ear fulfills more than one role. It has the smallest set of bones in the body, and they facilitate hearing. But it also plays an essential part in balance and body coordination.
Meniere’s disease is a problem in the internal portion of the ear. This portion of the ear has a complex structure called the labyrinth. It has a bony outer part and a membranous labyrinth in the inner part.
The cochlea performs most of the hearing function. It resembles a snail shell’s shape, twisted upon itself, and connected to the eighth cranial nerve. As the sound moves the liquid and the small structures in the cochlea, the sound is perceived by the vestibular nerve. Then, it is transmitted to the brain.
The inner brain also has the semicircular canals. They look like small arcs in different directions; anterior, posterior, and lateral. These canals are filled with fluid and sense body position depending on the inner ear fluid’s position.
When the body is tilted forward, backward, or to the sides, the liquid changes its position. The same cranial nerve receives this signal and sends it back to the brain.
This is how the inner ear works in healthy individuals, which is vital in Meniere’s disease.
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What is Meniere’s disease?
Meniere’s disease is an inner ear disorder that causes vertigo. According to recent reports, an estimated 615,000 people suffer from this disease in the United States.
Vertigo in Meniere’s disease is felt as an uncomfortable sensation of spinning around. For some reason, patients with Meniere’s disease have dysfunctional inner ears, which gets the labyrinth’s signals wrong. The patients feel their world is spinning when they are not moving at all.
This disease is usually located in one ear, not in both. It may also affect hearing function to a certain degree. After some time, patients start feeling the same symptoms in the other ear. Certain habits may increase the risk or worsen the disease, especially smoking and certain infections.
Vertigo attacks are usually associated with intense nausea and sometimes vomiting. Patients often lose their balance, and the disease may trigger elderly falls and other significant problems. Permanent hearing loss is a common consequence, too. However, treating nausea and severe dizziness is possible with medications (1).
What causes Meniere’s disease?
Meniere’s disease is a degenerative problem of the inner ear. The ear fluid, called endolymph, is accumulated in the inner ear. This accumulation creates false signals in the brain. Thus, patients feel the world is spinning around because of an erratic signal in the brain.
The exact reason why endolymph accumulates in the brain is not known. However, there are several theories about it. We have a vascular theory, a viral infection theory, an immune theory, and a genetic predisposition theory.
Usually, the endolymph is absorbed in a structure known as the endolymphatic sac. This sac is expanded in patients with Meniere’s disease.
The endolymphatic sac pushes another chamber with liquid, called the perilymphatic chamber. This perilymphatic fluid is vital for hearing. That’s why patients experience tinnitus and hearing problems.
Theories
Vascular: The vascular theory is mostly about blood flow changes. These changes and increased permeability contribute to endolymph creation. There’s more endolymph than it should be, and that’s why it accumulates.
Viral infection: The viral infection theory is about herpes simplex virus and how it reactivates in the vestibular ganglion. When it does, it would activate antibodies and trigger inflammation in the inner ear. Inflammation would change the blood flow and reduce the absorption of endolymph. This causes an accumulation of liquid in the inner ear.
Immune: The immune theory follows a similar pattern. For many years, allergies and other immune-related conditions have been associated with Meniere’s disease. Around half of the patients have food or airborne allergies. Similar to viral infection reactivation, allergy causes an increase in inflammation. This affects the capacity of the sac to filtrate endolymph. Thus, the patient would have reduced output and fluid accumulation.
Genetic predisposition: Finally, genetic predisposition is usually reported in up to 12% of patients. Having family members with Meniere’s disease increases the chance of having it yourself (1, 2, 3).
What are the symptoms of Meniere’s disease?
The symptoms of Meniere’s disease include (1):
- A sensation of ear fullness or pressure: It is also known as aural fullness. This is a dull and inaccurate symptom reported by patients as a sensation of fullness in the affected ear. This is due to endolymphatic hydrops. The increase in pressure pushes the perilymphatic chamber, giving rise to hearing loss and uncomfortable ear pressure.
- Tinnitus: This is often described as ringing, humming, hissing, or whistling sounds. It is an abnormal sound that is not there but is perceived by the changes in the endolymph.
- Sensorineural hearing loss: This hearing loss is fluctuating and progressive. In most cases, it affects low frequencies. Thus, it is known as low-tone deafness.
- Episodic vertigo: This is the most commonly reported symptom because it is the most debilitating symptom. Vertigo is a sensation that the world is spinning around you. It is incapacitating and very distressing for patients because it causes balance problems. Disequilibrium and falling are often associated with vertigo, as well as nausea with or without vomiting. It is essential to highlight that vertigo feels like the room is spinning around you. It is very different from dizziness, which feels like you’re revolving on your feet.
How is Meniere’s disease diagnosed?
Diagnosing Meniere’s disease requires a clinical history, a physical exam, and a few tests.
It is crucial to evaluate the patient’s family history of Meniere’s disease in the clinical record. It is also essential to assess what medication the patient is using and his underlying health problems.
Some of them may explain vertigo and other symptoms of Meniere’s disease. The clinical history should also include the results of physical exams and tests. With all of this information, it is possible to diagnose Meniere’s disease. The diagnosis is clinical, and there is no standardized test for the condition (1).
Affected individuals are diagnosed only when they have two or more episodes of:
- Vertigo, unexplained by any other reason
- Hearing loss in the fluctuating pattern described in Meniere’s disease
Hearing loss
Hearing loss episodes should be confirmed by audiometry, a simple hearing test. Vertigo can be established by nystagmus, an involuntary eye movement triggered by this condition.
It is imperative to perform audiometry tests in patients with suspected Meniere’s disease. If they do not have any obvious hearing loss problem, the audiometry is still recommended.
A low-tone hearing deficit and other symptoms previously described are highly suggestive of Meniere’s disease. Another problem these patients usually have is speech discrimination. They often fail to distinguish some words with similar sounds, such as fit and sit.
Vertigo
Vertigo can be evaluated objectively through an electronystagmography. This prompts vertigo through the movement of the body, and a video camera records eye movement.
With this technology, it is possible to record and quantify nystagmus. It looks like an oscillation of the eyes when the patient feels severe vertigo. It is similar to body tremors with a rhythmic pattern.
Besides the movements of the body, electronystagmography also applies cold and warm water into the ear. This induces vertigo episodes and reproduces nystagmus.
Additionally, patients may need an electrocochleography. This test is designed to detect a distention in the inner ear’s basilar membrane. This gives the doctor a measure of endolymphatic hydrops. It is an accurate way to assess the pressure of the inner ear.
In some cases, additional studies may be recommended to rule out other diseases, such as multiple sclerosis, stroke, acoustic neuroma, and Arnold Chiari malformations.
How is Meniere’s disease treated?
The exact underlying causes of Meniere’s disease are not known. But we do know that an increase in endolymphatic fluid triggers the symptoms. Thus, the main goal of the treatment is stabilizing and improving the volume of liquid.
Other goals include controlling vertigo, preserving the hearing function, and improving the quality of life.
This is achieved by using one or a combination of these therapeutic options (1, 2):
- Stress reduction: It is known that stress causes a worsening in the symptoms of Meniere’s disease. Thus, stress reduction is an essential part of the treatment to improve quality of life. That’s why doctors often recommend deep breathing techniques, exercise, yoga, and other techniques.
- Nutritional changes: Certain substances are known to increase the production of endolymphatic fluid. They should be avoided. For example, sodium should be restricted to 1,000 or 2,000 mg. This reduces the risk of rupture in the endolymphatic sac. This is fundamental for the initial therapy. Foods high in sugar, alcohol, and caffeine should also be restricted. Caffeine is a vasoconstrictor and affects the blood flow. Alcohol changes the electrolytes in the blood and the movement of the fluid. And both the high sugar and low sugar in the blood may trigger an increase in endolymphatic fluid, too.
- Diuretic treatment: Diuretics are made to decrease excess fluid from the body. The patients should increase the intake of fluids and control the potassium and sodium levels. In most cases, a combination of diet and diuretics improves the balance and hearing symptoms.
- Corticosteroid treatment: This is a more aggressive therapy. It is only used in patients who are not controlled with diuretics and dietary changes. Corticosteroid medications reduce edema rapidly and are used in the short-term. When using this treatment, doctors should monitor blood cell count, electrolytes, and other parameters.
- Positive pressure therapy: This therapeutic option uses a positive pressure device. It is placed in the external ear and generates positive pressure pulses. The pressure travels to the inner ear through a tympanostomy tube. This leads to endolymphatic sac decompression. It is useful in up to 85% of patients.
- Other treatment options: We also have more severe treatments that require a modification of the vestibular system. They are vestibular neurectomy, labyrinthectomy, and other methods. These are very aggressive approaches, only meant for severe cases. These are surgical procedures and only performed when there’s no other treatment option.
- Hearing aids: Many patients with Meniere’s disease require hearing aids. Vestibular rehabilitation is also fundamental to improve balance function.
What effect does diet have on Meniere’s disease?
As noted above, dietary changes are an essential part of the treatment. In many cases, a combination of nutritional changes and diuretics is enough to control the symptoms.
We mentioned a few dietary recommendations above, but this is the complete list (2, 4):
- Low salt diet: This is the first-line recommendation for Meniere’s disease patients. The recommended intake should always be under 2,000 mg of salt. This is thought to reduce the ear pressure in the endolymphatic sac. It is found to improve the severity of vertigo. Thus, many authors recommend this measure as a part of the treatment. The link is apparently through an increase of aldosterone. This hormone promotes the reabsorption of endolymphatic fluid.
- Abundant water intake: This is often regarded as water intake therapy. In some patients, it prevents hearing loss and improves vertigo. More water decreases the levels of ADH hormone and reduces endolymphatic pressure.
- Limiting alcohol and caffeine: Caffeine has been detected as a precipitating factor in Meniere’s disease. Some authors would also recommend limiting alcohol for electrolyte changes that may occur.
- Gluten-free diet: Meniere’s disease is associated with immunity issues and food intolerance. Thus, a restrictive gluten-free diet may be helpful for some patients. They would reduce their systemic inflammation and improve their symptoms, as reported by scientific evidence.
- Processed cereals: Processed flakes and cereals may also predispose to Meniere’s disease and should be avoided.
What lifestyle changes may help the symptoms of Meniere’s disease?
In addition to medical treatment and dietary changes, Meniere disease patients benefit from a few lifestyle modifications (5):
- Stop smoking: This is an important recommendation for patients with Meniere’s disease. Smoking is associated with changes in the blood vessels and the immune system. Both of them trigger Meniere’s disease.
- White noise: Many patients describe a significant improvement when they use white noise devices. Turning on the fan is another alternative. This is useful to reduce the humming sound of tinnitus, especially at night. Along with hearing aids, this is a fundamental recommendation for these patients.
- Being attentive to body cues: After a while, patients understand more about their disease and body cues. Loud noises, bright lights, and other stimuli may trigger the symptoms of Meniere’s disease. So, patients are recommended to pay significant attention to their own bodies and understand their own condition. By making changes accordingly, they would reduce the severity and frequency of symptoms.
- Stress management techniques: Stress management is also fundamental for Meniere’s disease. Stress triggers a series of changes in the immune system, favoring inflammation. After a cascade of events, this inflammation triggers an acute attack. To counter this problem, we could use a combination of mindfulness techniques, deep breathing, and yoga. Some patients are recommended to stress management courses and therapy.
Conclusion
Menieres’ disease does not have a cure, but it can be managed by combining therapeutic options. Finding out the right combination is a process that involves continued trial and error. Thus, try not to feel frustrated in the process, and feel reassured that you will ultimately find a solution that feels right for you.
