Meniere’s Disease

About the Disease

Meniere’s disease is a chronic vestibular disorder caused by fluctuating pressure of inner ear fluid. It presents with recurrent episodes of spinning with fluctuating hearing loss in one ear. It is a slowly progressive disease which should be treated at the earliest to prevent long-term complications. Increased fluid pressure causes the inner ear to expand like a balloon which leads to recurrent episodes of vertigo, hearing loss, ringing sound in the ear (tinnitus). Meniere’s disease can develop at any age, but it is more likely to occur in people of the age of 30–60 years.

Symptoms

Vertigo: The most bothersome complaint in Meniere’s disease is unpredictable recurring episodes of vertigo which may last for about 20 minutes to several hours. The vertigo bouts are often accompanied by nausea and vomiting.
Hearing Loss: Fluctuating hearing loss in one ear is one of the earliest symptoms of Meniere’s disease. As the disease progresses, the temporary hearing loss may become a permanent disability.
Tinnitus (ringing in the ear): Tinnitus is a perceived sound of ringing or buzzing in the ear. In the initial stages, the sound may come and go but with disease progression, the sound may become a constant feature.
Fullness in the ear: Patients suffering from Meniere’s disease often feel pressure in the affected ear (aural fullness) or on the side of their heads before the spell of vertigo starts. This feeling may decrease after the vertigo spell subsides.

Diagnosis

A detailed history followed by thorough Vestibular Evaluation and Audiometry will help the doctor reach the diagnosis and stage of disease. According to the test results, the treatment is planned.

Treatment

The treatment for Meniere’s disease focuses on relieving the symptoms of the disease, reducing inner ear pressure and preventing disease progression.
This would be achieved through various measures –

Dietary modifications.
Medication are aimed to:
- Control the vertigo attack
- Reduce inner ear pressure
- Treat the disease pathology
Vestibular Rehabilitation Therapy: Once the acute symptoms are controlled, the patient can be assisted with customized vestibular rehabilitation treatment.
Intratympanic Injections: In patients who do not respond well to medical management, we offer intratympanic injections in the form of steroids and gentamicin. This helps to reduce inner ear pressure by providing a higher concentration of drug locally in the ear without systemic side effects.
Hearing Aids: When hearing loss becomes constant and affects the day-to-day life of the patient, hearing aids can be used to improve hearing outcomes.
Surgery: Surgery is rarely indicated in Meniere’s disease. It remains one of the last options to treat intractable Meniere’s disease when the vertigo episodes are severe and frequent.

Causes and Risk Factors of Meniere’s Disease

The exact cause of Meniere’s disease is not fully understood, but it is believed to be associated with abnormal fluid buildup in the inner ear, known as endolymphatic hydrops. Several factors may contribute to this imbalance:

Possible Causes

Abnormal Fluid Regulation: Improper drainage or overproduction of endolymph (inner ear fluid) can lead to pressure changes.
Viral Infections: Inner ear infections, particularly viral labyrinthitis, may trigger the onset of Meniere’s disease.
Genetic Predisposition: A family history of Meniere’s disease may increase the risk, suggesting a possible hereditary component.
Autoimmune Response: Some studies suggest that the body’s immune system may mistakenly attack inner ear structures.
Head Trauma: Injury to the head or ear can disturb the balance and hearing mechanisms, potentially triggering Meniere’s disease.
Allergies: Certain allergic reactions may contribute to fluid imbalance in some individuals.

Common Risk Factors

Age: Most commonly affects adults between 30 and 60 years.
Family History: Having close relatives with Meniere’s disease may increase your likelihood of developing it.
Migraine: There is a known association between migraine sufferers and a higher incidence of Meniere’s disease.
Autoimmune Conditions: People with autoimmune diseases may have a higher risk due to possible immune-related damage to the inner ear.
Smoking and High Salt Intake: Both can contribute to poor circulation and fluid retention, potentially worsening inner ear pressure.

Dietary Recommendations for Managing Meniere’s Disease

Diet plays a crucial role in managing Meniere’s disease by helping to control the fluid balance in the inner ear and reduce the frequency and severity of vertigo episodes. Here are key dietary guidelines commonly recommended:

1. Low-Sodium Diet

Reducing salt intake helps minimize fluid retention in the body, including the inner ear, which may lower inner ear pressure and prevent vertigo attacks.

Aim for less than 1,500–2,000 mg of sodium per day.
Avoid processed foods, canned soups, salty snacks, and pickled items.

2. Limit Caffeine and Alcohol

Caffeine (found in coffee, tea, chocolate, and soft drinks) can overstimulate the nervous system and exacerbate tinnitus and dizziness.
Alcohol may alter the fluid composition in the inner ear and worsen symptoms.

3. Stay Hydrated

Drinking adequate water throughout the day can help maintain fluid balance and reduce the risk of sudden pressure changes in the inner ear.

4. Balance Sugar Intake

Fluctuating blood sugar levels may contribute to inner ear pressure changes. Try to:

Eat regular, balanced meals.
Avoid excessive intake of refined sugars and processed carbohydrates.

Nationwide care with 200+ clinics in 54+ cities.

Ménière’s Disease at a Glance

Ménière’s Disease is a chronic inner ear disorder that is marked by unpredictable attacks of vertigo, loss of hearing that comes and goes, a ringing sensation in the ears, and fullness in the ear. In contrast to temporary dizziness, that of Ménière is recurring and may have a severe quality of life impact.

Prevalence

Meniere’s disease is one of the most prevalent chronic disorders of the vestibular system because it is the example of the disease that the National Institutes of Health (NIH) uses as the disease occurs in about 12 people out of 1000 in the whole world. It is usually diagnosed during middle age but it may occur in individuals who are not of average age; i.e., 40-60.

Underlying Cause

Endolymphatic hydrops, which is the increase of fluid in the inner ear, is the hallmark of Méniere disease. This surplus fluid interferes with the signals that the balance organs send to the brain, causing dizziness, changes to hearing, and tinnitus. The precise cause of this fluid imbalance is not understood but has been thought to be due to a combination of genetic factors, immune factors and environmental factors.

Management Strategies

Treatment does not exist, though in the majority of cases the symptoms can be treated by a combination of techniques:

Lifestyle measures – Low sodium diet and limited caffeine/alcohol reduce fluid retention.
Medication – This may be assisted by diuretics, anti-nausea, or vestibular suppressants.
Vestibular rehabilitation – Combined treatment to improve balance and reduce dizziness.

How Ménière’s Differs from Other Vertigo Conditions

The cause and treatment response of Méniere is different, compared to other common vestibular disorders:

BPPV – This is caused by the movement of inner ear crystals (otoconia) and is usually stopped by the repositioning maneuvers.
Vestibular neuritis – This is due to the inflammation of the vestibular nerve by a virus, which causes imbalance that happens suddenly but only temporarily.
Whereas in Meniere’s disease, the condition is associated with fluid balance issues in the inner ear, making maneuvers such as the Epley, which are effective in BPPV, largely ineffective.

Knowing the differences is the most important to manage and prevent unnecessary or ineffective treatment.

When to See a Doctor

Although many individuals with Meniere’s can manage symptoms at home immediate medical attention is required if you experience:

Acute or extreme vertigo episodes which result in falls or fainting.
Sudden or irreversible hearing impairment, particularly when it occurs only in one ear.
Neurological red flags that include: vision duplication, weakness, face drooping or challenges in talking; this is more likely to be a stroke than a problem of the inner ear.
Recurrent debilitating attacks disrupting work, driving or everyday life despite therapy.

Immediate management with an ENT specialist or a neurologist will help to make a proper diagnosis and avoid complications in the long term.

Meniere’s Disease

About the Disease

Symptoms

Diagnosis

Treatment