Meniere’s Disease: Symptoms, Causes, Complications, Diagnosis, Treatment and Prognosis

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A doctor check if the patient suffers from Meniere's Diseases

1Overview

The ears are very important parts of the body. They are there for the sense of hearing and if there are problems with any part of the ear, hearing difficulties are present. The ear is an advanced and very sensitive organ of the human body. Its main function is to transmit and transduce sound to the brain, for interpretation.

There are three major parts of the ear – the inner ear, middle ear and outer ear.
These parts all work together to hear and process sounds. The outer ear is considered the catch basin of sound waves. It is called the auricle or pinna, the part of the ears that people can see. The main purpose of this part is to collect sounds, even the soft ones or the loud ones.

The middle ear, on the other hand, is where the sound waves are turned into vibrations to be delivered to the last part of the ear, the inner ear. In the middle ear, the eardrum is present, which is there to take the sound waves and transform them into vibrations to be delivered to the inner ear. It also separates the outer ear from the middle ear and the ossicles. These are three tiny and delicate bones in the body – the malleus (hammer), incus (anvil) and stapes (stirrup).

The inner ear is where the vibrations created by the eardrum and passed through the three tiny bones is received, This part of the ear contains the cochlea, a small and curled tube.
It is also filled with fluid which will move like a wave when the vibrations enter the inner ear.

In the cochlea, there are tiny cells inside microscopic hair strands. They move when the vibrations are felt, producing nerve signals that the brain can understand and interpret.

One condition that affects the inner ear is Meniere’s disease, which is a disorder of the inner ear. When a person has Meniere’s disease, he or she may have episodes of vertigo or the feeling of spinning around. Moreover, there are episodes of fluctuating hearing loss.

Aside from vertigo, people with Meniere’s disease also have hearing loss, a feeling of fullness or congestion inside the ear, and ringing in the ears (tinnitus). However, this disease will only affect one ear.

Though Meniere’s disease can develop at any age, it is more likely to happen top adults between 40 and 60 years old.

2Symptoms

Meniere’s disease symptoms come in episodes or attacks and many people with the condition do not experience any symptoms between episodes.

The signs and symptoms of Meniere’s disease include:

  • Ringing in the ear (tinnitus) – Tinnitus is the perception of sounds like ringing, roaring, hissing, whistling, and buzzing in the ears. Only you can hear these sounds.
  • Recurring episodes of vertigo – Most people with Meniere’s disease experience the sensation of spinning that starts and stops spontaneously. This is called vertigo and it can occur without warning as it lasts for about 20 minutes to a few hours. In severe cases, there is nausea and vomiting.
  • Feeling of fullness or pressure in the ears – Individuals with Meniere’s disease feel the pressure inside the affected ear, wherein there is a feeling of congestion and aural fullness.
  • Hearing loss – The feeling of hearing loss come and go and most people may also suffer from the permanent hearing loss.

3Causes

The exact cause of Meniere’s disease is still not fully understood. One famous theory is that Meniere’s disease is caused by the abnormal amount of endolymph (fluid) in the inner ear. However, some of the factors seen as possible causes of the disease are:

  • Abnormal immune response
  • Allergy
  • Viral infection
  • Improper fluid drainage
  • Genetics
  • Trauma to the head
  • Migraines

4Complications

Meniere’s disease, if not controlled and managed, may cause hair cell death in the ears and some mechanical changes in the ears.

When there is an admixture of the endolymph and perilymph, it may lead to the death of the hair cells in the inner ear, which carry impulses to the brain. This process slowly progresses through the years and would eventually lead to unilateral functional deafness.

Aside from hearing loss, there might be a mechanical disruption of the inner ear. Pathological findings of Meniere’s disease show that the utricle and saccule become dilated. This would result in chronic unsteadiness and loss of balance even without having an attack.

Moreover, the unpredictable attacks of vertigo and permanent hearing loss can be the most difficult complications of Meniere’s disease. The disease can take a toll on the patient’s life and daily activities, eventually leading to problems such as fatigue, depression, anxiety and emotional stress.

Moreover, vertigo causes loss of balance, increasing the risk of accidents and falls, particularly when the patient is operating heavy machines and driving.

5Diagnosis

The doctor will conduct a complete physical assessment and medical history.
To diagnose Meniere’s disease, here are the requirements:

  • Hearing loss verified by a hearing test
  • Tinnitus or a feeling of pressure or fullness in the ear
  • Two episodes of vertigo that lasted for 20 minutes or longer but not over 24 hours
  • Exclusion of other underlying causes of these symptoms

Diagnostic tests

Hearing test – A hearing test is utilized to determine if you are experiencing hearing loss of some degree. Also called audiometry, the patient is asked to put on headphones as he or she will hear noises with varying volumes and pitches. The patient needs to determine if he or she can’t hear a tone.

Moreover, the test will see how well a person can detect the sounds and distinguish between similar-sounding words. People with Meniere’s disease may find it hard to hear low-frequency sounds and those combined low frequencies and high frequencies with normal hearing.

Balance assessment – Balance tests are used to test the function of the inner ear because those with the disease may have a decreased balance response in the affected ear. The common tests used for testing balance include:

Videonystagmography (VNG) – This test examines the balance by assessing eye movement. The sensors in the inner ear responsible for balanced are connected to the muscles that control the movements of the eyes. In this test, warn and cold water or air are inserted into the ear canal and the involuntary movements of the eyes are measured in response to the stimulations.

Electrocochleography (ECoG) – This is the most common balance test used for Meniere’s disease. In this test, the inner ear is assessed in response to sounds.

Rotary-chair testing – This test is like VNG because it also measures based on the eye movements. In this test, however, the patient will sit in a computer-controlled rotating chair that can stimulate the inner ear and eye movements will be measured.

Vestibular evoked myogenic potentials testing (VEMP) – This is just a new test that can help diagnose Meniere’s disease. It can also help monitor the disease. It detects changes in the affected ears of individuals diagnosed with Meniere’s disease.

Video head impulse test (vHIT) – The new test utilizes a video to measure the eye reactions to sudden movements. The patient is asked to focus on one point and the head is turned abruptly. If the eyes move off the target when the head is turned, there is an abnormal reflex.

Posturography – This test shows the part of the balance system has problems. The parts tested are the eyes, inner ear junction, muscles, tendons and joints, and the sensations from the skin.

Other tests – The other tests used often deal with the issues in the brain such as a tumor or multiple sclerosis. The doctor may request imaging tests such as a CT scan or an MRI, to rule out possible problems in the brain that may cause balance and hearing problems.

6Treatment

There is no cure for Meniere’s disease, but there are drugs that can help relieve nausea and vomiting, and vertigo.

Medications – Meniere’s disease symptoms can be managed through treatments such as medications. Motion sickness medicines are used to ease the symptoms of vertigo, nausea, and vomiting. However, an antiemetic or anti-nausea medication can be given for severe nausea and vomiting.

In some cases, since one of the possible causes of Meniere’s disease is a problem with the fluid found in the inner ear, the doctor may prescribe a diuretic. This will help reduce the amount of fluid the pressure buildup inside the ear. Some doctors may even inject medications into the inner ear to help decrease vertigo symptoms.

Hearing aids and rehabilitation – Some exercises, like vestibular rehabilitation exercises, can help improve the symptoms of vertigo. The exercises will train the brain to adapt to the changes in the balance between the two ears. Moreover, an audiologist can treat hearing loss through hearing aids.

Surgery – Most people with Meniere’s disease do not need surgery. However, it can be done on patients with severe attacks and those who do not respond to other treatments.

7Prognosis

Since the symptoms of Meniere’s disease are episodic, it is essential that other people would know what might happen when you have an attack. This way, you can be safe from certain accidents and falls.

Since there is no cure, a person can have the condition for a lifetime. However, if the symptoms are managed appropriately, there is a good quality of life for most patients.

However, the disease can affect one’s social life, the productivity and overall quality of life.