Meniere's disease, named after the French physician Prosper Ménière, is a relatively rare disorder affecting 0.2% of the U.S. population. Excess fluid in the membranous labyrinth of the inner ear causes it. It is also known as endolymphatic hydrops.
Symptoms include episodes of vertigo (a feeling of movement when they are still) accompanied by nausea and vomiting, tinnitus (a ringing sensation in the ear), a feeling of fullness in the ear, and fluctuating hearing loss. Meniere's can be differentiated from benign paroxysmal positional vertigo (BPPV) by the additional presence of tinnitus, hearing loss, and nature of vertigo attacks. Vertigo in Meniere's will usually abate within 24 hours, longer episodes point to vestibular problems.
Excess fluid in the inner ear is either due to increased production, decreased fluid drainage in the inner ear (endolymph), or a combination of both. The majority of Meniere's disease has an unknown cause (idiopathic). It mainly affects males aged 35-60 and starts in one ear but may affect the other in a few years.
Doctors perform Hallpike's test to differentiate between Meniere's BPPV, however, BPPV can result from Meniere's. Epley's maneuver is done to reposition crystals in the inner ear and provide relief from vertigo. Pure tone audiometry, caloric test is very useful. MRIs are done to look for auditory nerve lesions (eg. acoustic neuroma).
Grappling with a diagnosis of Meniere's disease can be difficult. Especially since the exact mechanism of it is unknown. It is important to reassure patients with the disease and relieve their anxiety. Some general precautionary measures include quitting smoking, avoiding excess water and salt intake, coffee, tea, and alcohol, and avoiding stress. Some patients may require a career change if they are in a profession that requires balance.
During an acute attack of Meniere's, bed rest and rehydration are advised. Doctors prescribe drugs such as vestibular sedatives and vasodilators. Living with Meniere's in the long run requires medication (Betahistine, Prochlorperazine), lifestyle or career changes, elimination of allergens, and management of endocrine disorders. If the disease cannot be controlled by medicine alone, patients are advised to undergo surgery to relieve debilitating symptoms. A labyrinthectomy can be done but leaves the patient with a dead ear. Intratympanic injections of aminoglycosides or sectioning of the vestibular nerve are conservative procedures that can control vertigo without affecting hearing loss. However, the patient may still experience disequilibrium if they are not able to compensate with their other ear.
The outcome is variable, but patients generally experience less severe vertigo as the years go on. However, hearing loss increases. Nonetheless, a diagnosis of Meniere's is not the end! Music moguls like Peggy Lee, Les Paul, Randy Thurman, and Huey Lewis all had Meniere's, but they persisted despite their illness.
Bibliography: danas@soundst.com. (2021, August 29). People With Meniere’s Disease: A List of Famous and Influential People. Neil Sperling, MD. https://www.neilsperlingmd.com/blog/2021/08/people-with-menieres-disease/ Dhingra, P. L., & Dhingra, S. (2021). Diseases of Ear, Nose & Throat and Head & Neck Surgery - E-Book. Elsevier India. Ménière’s Disease: Symptoms, Causes & Treatment. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15167-menieres-disease Meniere’s Disease. (n.d.). American Hearing Research Foundation. Retrieved October 25, 2023, from https://www.american-hearing.org/disease/menieres-disease/
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