Meniere's disease

Symptoms of Ménière's disease

Ménière's disease causes episodes that come on suddenly and can last anywhere from 20 minutes to 24 hours. The main symptoms, which usually occur together, are:

• vertigo, a spinning sensation that can be severe enough to make you lose your balance or fall
• hearing loss, usually in one ear, often affecting lower-pitched sounds first
• tinnitus, a ringing, buzzing or whooshing sound in the affected ear
• a feeling of pressure or fullness deep in the ear.

You may also feel or be sick during an episode. Afterwards, it's common to feel exhausted and need to sleep for several hours, and it can take a day or two for symptoms to disappear completely.

Episodes can happen close together over a few days, or be separated by weeks, months or even years. Over time, hearing loss and tinnitus tend to become more constant, while, for many people, the vertigo attacks eventually become less frequent.

Having these symptoms doesn't necessarily mean you have Ménière's disease. Conditions with similar symptoms include ear infections, labyrinthitis or vestibular neuritis, and migraine, so it's important not to self-diagnose.

Causes of Ménière's disease and who is at risk

The exact cause of Ménière's disease isn't known. Symptoms are linked to a build-up of fluid, called endolymph, in a part of the inner ear called the labyrinth, which contains the organs of hearing and balance. This fluid build-up is thought to disrupt the balance and hearing signals sent to your brain.

Possible contributing factors include:

• allergies
• blockages that stop fluid draining properly from the inner ear
• a head injury
• viral infections
• migraine
• an autoimmune reaction, where your immune system mistakenly attacks healthy tissue.

You may be more likely to develop Ménière's disease if you:

• are aged between 40 and 60
• have a family history of the condition
• have an autoimmune disease, such as rheumatoid arthritis or lupus.

Some people also find that certain things trigger an episode, such as stress, tiredness, salty food, or changes in air pressure.

Are there different types of Ménière's disease?

Rather than distinct types, Ménière's disease is usually described by how certain the diagnosis is, and how far it has progressed.

Doctors may describe your diagnosis as:

• Definite Ménière's disease, where hearing loss has been confirmed by a hearing test alongside your other symptoms.
• Probable Ménière's disease, where you have the typical pattern of symptoms, but hearing loss hasn't yet been confirmed by testing.

The condition also tends to change over time. In the earlier stages, hearing loss often comes and goes alongside vertigo attacks. In later stages, hearing loss and tinnitus tend to become more constant, while vertigo attacks may become less frequent.

How Ménière's disease is diagnosed

There's no single test for Ménière's disease. A GP will ask about your symptoms, check inside your ears, and examine your head and neck. They may also ask you to do simple balance exercises, such as marching on the spot.

If they think you may have Ménière's disease, you'll be referred to a specialist, usually an ear, nose and throat (ENT) doctor, for further tests. These can include a hearing test, tests that check your balance reflexes and eye movements, and an MRI scan to rule out other causes, such as a brain tumour.

How Ménière's disease is treated

There's no cure for Ménière's disease, but a range of treatments can help reduce how often and how severely symptoms occur.

Lifestyle changes that may help include following a low-salt diet, cutting down on caffeine and alcohol, managing stress, and getting enough rest. Medication can help relieve dizziness and sickness during an episode, and some people are prescribed a diuretic (“water tablet”) or a medicine called betahistine to help reduce fluid pressure in the inner ear between episodes.

If these approaches aren't enough, your specialist may recommend an injection into the middle ear, either a steroid or an antibiotic called gentamicin, to help control vertigo. Gentamicin is usually reserved for more difficult cases, as it carries a risk of further hearing loss.

Other treatments include hearing aids, help managing tinnitus, and vestibular rehabilitation, a type of therapy that helps retrain your balance system. Counselling can also help with the impact Ménière's disease can have on your mental health.

Surgery is rarely needed and is only considered if other treatments haven't controlled your symptoms. Options include an operation to relieve pressure in the inner ear, cutting the nerve that carries balance signals to the brain, or, in severe cases where hearing in the affected ear is already lost, removing the balance organ itself.

When to see a doctor

See a GP if you have symptoms of Ménière's disease, such as episodes of vertigo, tinnitus, hearing loss or ear pressure.

Call 999 if you feel like you or everything around you is spinning and you also have:

• drooping on one side of your face
• difficulty lifting and holding up both arms
• slurred or garbled speech
• sudden vision problems in one eye.

These can be signs of a stroke, which is a medical emergency. Do not drive yourself to hospital.