Meniere's – is this the devils work?
30 April 2021
A heartfelt article compiled by Ian Arnold – Independent hearing professional
My family, work colleagues and myself have been helping people hear their family and friends better since 1936, in my experience one of the most emotionally distressing hearing and balance related conditions that one could be unfortunate to experience is Ménière’s Disorder. In its simplest form it is a result of overproduction of endolymph fluid in the inner ear.
More commonly called Ménière’s Disease, a description I am not fond of because when you understand what causes this dilapidating condition it is not a disease, it is a disorder.
Ménière’s disease, also commonly referred to as endolymphatic hydrops, is a disorder of the inner ear causing vertigo. It is a result of overproduction of endolymph fluid in the inner ear. This increase in fluid causes an increase in pressure within the organ resulting in progressive degeneration of the hair cells in the inner ear. Patients with Meniere’s disease or endolymphatic hydrops have complaints of attacks of vertigo that can last hours at a time, pressure or a fullness sensation in the ear, tinnitus (ringing), and fluctuations in hearing.
Because the endolymph fluid is present throughout both the auditory and vestibular portions of the inner ear, most patients experience both auditory and balance symptoms. However, some patients may just experience auditory or balance symptoms in isolation.
Ménière’s often begins with one symptom, and gradually progresses. However, not all symptoms must be present for a doctor to make a diagnosis of the disease. Several symptoms at once are more conclusive than different symptoms at separate times.
Attacks of vertigo can be severe, incapacitating, and unpredictable. Some sufferers experience what are informally known as “drop attacks“ – a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall. Patients may also experience the feeling of being pushed or pulled (Pulsion). Some patients may find it impossible to get up for some time, until the attack passes or medication takes effect. Hearing may improve after an attack, but often becomes progressively worse. Attacks often come in series of a few minutes to a few hours and can sometimes be accompanied by Nausea, vomiting and sweating.
In addition to hearing loss, sounds can seem tinny or distorted, and patients can experience unusual sensitivity to noises (hyperacusis). Some sufferers also experience nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements.
The symptoms experienced can change over time
Ménière’s disease occurs in repeated ‘attacks’ or episodes lasting from minutes to hours. The time between ‘attacks’ varies from weeks to years and is very unpredictable. Some people can tell an ‘attack’ is going to start because of a blocked feeling in the affected ear.
Usually, the disease affects only one ear, however the Ménière’s Society suggests that up to 50% of sufferers have a progression of the disease to affecting both ears. During an attack, people with the disease may be unable to carry on with their daily life until the symptoms have started to improve. They may also feel nauseous and might be sick.
If your GP suspects that you have Ménière’s disease, they will usually refer you to an ENT specialist for further assessment.
A hearing test is usually done which will show any hearing loss on the affected side. Ménière’s disease often causes a low pitch (low frequency) sensori-neural hearing loss in the affected ear. The hearing loss may change during ‘attacks’ but usually becomes permanent with repeated damage. Your ENT (Ear, Nose and Throat) specialist might also request specialist balance (vestibular) testing which may help to identify the affected ear.
Other tests such as scans or blood tests might be done to help rule out other illnesses that may cause the three common symptoms of Ménière’s disease: vertigo, tinnitus and hearing loss. A diagnosis is usually based partly upon the pattern of symptoms that an individual is suffering.
There is no cure for Ménière’s disease however there are medications and other treatments that may improve symptoms. If medication is found to improve the symptoms, the diagnosis can be more strongly confirmed.
There are a number of ways of treating Ménière’s disease.
Your GP or ENT specialist might prescribe medication to help make attacks less severe and occur less often. This might be medication for your balance or medication to reduce water retention (diuretic). Your doctor might also suggest that you reduce the amount of salt in your diet.
Special balance (vestibular) exercises may be suggested if you have any dizziness or imbalance between attacks.
You might be referred to a specialist tinnitus clinic for more help and advice if you have tinnitus between attacks.
If you have hearing loss in the affected ear and also notice that you have difficulty hearing clearly, a hearing aid may be helpful to you.
If you have ongoing difficulty adapting to and coping with your symptoms, counselling or other complementary therapies might also be useful.
Sometimes surgery or treatment applied directly to the inner ear on the affected side might be suggested by your ENT specialist. Although Ménière’s disease can be very frightening, seeking help and appropriate treatment can help to minimise the effect of symptoms on your life. Learning to manage your symptoms will allow you to continue with your daily activities as much as possible. Contact us for advice, information and support.