Meniere’s Disease – Diagnosis and Treatment
Diagnosis
Checking Hearing Ability
Ear specialists use special hearing exams called audiometry to find out if someone has Meniere’s disease. This test checks how well a person hears different sounds and pitches.
The test also checks if someone can tell apart words that sound nearly the same. People with Meniere’s disease often show signs of sensorineural hearing loss.
This hearing loss usually affects low sound frequencies and sometimes both high and low frequencies, while mid-range hearing can stay normal. Other symptoms might include tinnitus—a ringing or buzzing noise—and a sense of pressure in the ear.
These symptoms can get worse during and after vertigo attacks. A hearing test helps confirm if the loss is fluctuating or gets worse over time, which are common signs of this illness.
Key points in hearing assessment:
| Symptom | Common in Meniere’s |
|---|---|
| Hearing loss | Yes, often low/high |
| Tinnitus | Frequent |
| Ear pressure/fullness | Possible |
Doctors often use audiograms to track changes in hearing ability at different pitches. By tracking these changes over weeks and months, they can understand how the disease affects a person.
Checking Balance Function
Since Meniere’s disease mainly affects the vestibular system in the inner ear, doctors need to check how well balance is working. During attacks, people may have severe dizziness, trouble walking, or even vomiting.
After attacks, most people return to normal, but some might have ongoing balance problems or mild loss of balance. Doctors use several tests to check balance:
- Eye Movement Tests (ENG/VNG): Doctors look at eye movement while a person follows a target, after head movements, or during the caloric test (using warm or cold air or water in the ear). These tests measure how well the balance system works.
- Rotary Chair Test: The person sits in a chair that moves side to side. Doctors track eye movements to see if the inner ear reacts the right way.
- Vestibular Evoked Myogenic Potentials (VEMP): This test measures muscle responses after a sound is played in the ear. It checks if the inner ear and balance muscles respond normally.
- Computerized Dynamic Posturography (CDP): People wear a harness and stand barefoot on a platform. The test finds which parts of the balance system (like vision or inner ear) are causing the most trouble.
- Video Head Impulse Test (vHIT): With video glasses, doctors record the eyes during quick head turns. This checks if the eyes and inner ear reflexes work together.
- Electrocochleography (ECoG): Doctors study how the inner ear reacts to sounds, which can show fluid buildup known as endolymphatic hydrops, often linked to Meniere’s disease.
These tests help doctors figure out if inner ear problems are causing a balance disorder.
Screening for Other Possible Causes
Doctors use extra tests to rule out health problems that can look like Meniere’s disease. They may order blood tests, imaging like MRI scans, and other exams.
These tests help check for things such as:
- Brain tumors (which may also cause hearing and balance issues)
- Multiple sclerosis (which can mimic some symptoms)
- Migraine-associated vertigo or other types of vertigo
By using these screening tools, doctors can be more sure that the symptoms—such as episodes of vertigo, fluctuating hearing, or long-lasting dizziness—are truly from Meniere’s disease and not another cause.
Treatment
Medicines to Lessen Vertigo
Doctors often give medicine for vertigo when an attack starts. Antihistamines or benzodiazepines help reduce dizziness.
These drugs can also lower the risk of nausea and vomiting. Sometimes, antiemetics are used for nausea relief.
Diuretics may help lower the amount of fluid in the inner ear. Histamine analogs are also used to improve blood flow in the ear and decrease vertigo spells.
| Medicine Type | Main Purpose |
|---|---|
| Vestibular suppressants | Reduce spinning sensation |
| Anti-nausea/anti-emetics | Help control nausea |
| Fluid-reducing medicines (diuretics) | Lower ear fluid levels |
| Inner ear blood flow boosters | Lessen vertigo episodes |
Ongoing Medication to Control Symptoms
Long-term management aims to keep attacks from happening often. Patients might use diuretics for extended periods.
A low-salt diet is usually suggested to limit body fluid build-up. Medicines to retain less fluid are commonly prescribed for this purpose.
Non-Surgical and Supportive Options
Some people benefit from therapies that do not require surgery. Vestibular rehabilitation therapy can help those with balance problems between attacks.
These exercises focus on the body’s ability to control balance and can decrease symptoms over time. If hearing is affected, hearing aids are another option.
An audiologist can help select the best device for someone’s needs. These approaches make daily life easier, even if symptoms do not go away.
| Noninvasive Options | What It Does |
|---|---|
| Vestibular rehabilitation | Improves balance abilities |
| Hearing aids | Enhances hearing in affected ear |
| Low-salt diet | Reduces fluid retention |
Middle Ear Medication Injections
Doctors can inject special medicines through the eardrum into the middle ear in a clinic setting. They usually consider this if other treatments do not control vertigo.
- Aminoglycoside Antibiotic Injections: It is an antibiotic injection that targets inner ear balance cells. It quiets the vertigo but can make hearing loss worse, so doctors use it with caution.
- Steroid Injections: Steroids can ease vertigo attacks. They do not harm hearing as much as gentamicin, but may not work as reliably.
Surgical Procedures for Severe Cases
Doctors may suggest surgery when other treatments do not manage symptoms. Several operations exist:
- Endolymphatic Sac Procedure: This surgery helps control inner ear fluid by relieving pressure or draining the sac. Sometimes a small tube is added to aid fluid drainage.
- Labyrinthectomy: The surgeon removes the part of the ear responsible for balance in that ear. This leads to total hearing loss on that side, so it’s offered if hearing is already badly damaged.
- Vestibular Neurectomy (Nerve Section): The surgeon cuts the balance nerve. This stops abnormal signals from reaching the brain. Hearing in the affected ear is usually kept, but the surgery requires general anesthesia and a hospital stay.
| Surgery Type | Purpose | Risks/Notes |
|---|---|---|
| Endolymphatic sac operation | Manage inner ear fluid, relieve pressure | May place drain/tube |
| Labyrinthectomy | Remove balance organ in affected ear | Causes total hearing loss in ear |
| Vestibular nerve section | Cut balance nerve, keep hearing | Needs anesthesia + hospital stay |
Doctors choose each treatment based on the person’s health, hearing, and how severe their symptoms are. They work closely with patients to find the safest and most effective plan.
Ways to Manage at Home and with Daily Habits
Adjusting Daily Routines
Managing Meniere’s disease may involve making some key lifestyle updates. People can try sitting or lying down as soon as dizziness starts.
Sudden movements, harsh lighting, or activities like watching TV and reading can make symptoms worse. Focusing on a stable, non-moving object may help ease the feeling of spinning.
After a vertigo episode, rest is important. Rather than rushing back to normal activities, it helps to rest in bed for a while, then get up slowly.
This gentle process helps the body regain balance. Planning ahead can lower the risk of injury.
Talking with a healthcare provider about medicines for dizziness and when to get emergency help is useful. Creating a safe home, like clearing walkways and adding grab bars, can help prevent falls.
Diet changes are also important. Limiting salt to less than 2,300 mg per day and spreading out salt intake can sometimes reduce symptoms.
People can use the following table to track common dietary triggers:
| Trigger | How it may affect symptoms |
|---|---|
| Salt | May increase water in the body and cause episodes |
| Caffeine | Can worsen symptoms in some people |
| Alcohol | May trigger vertigo in certain cases |
| Tobacco | Sometimes linked to attacks |
To discover personal triggers, keeping a symptom journal is helpful. Noting what was eaten or done before a spell can help spot problem foods or habits.
Finding Help and Day-to-Day Support
People with Meniere’s disease may feel stressed or anxious as the condition can impact daily life and relationships. Learning more about the illness is an important first step.
Support groups offer a place to share tips and personal stories. You can connect with others in person or online. Ask a healthcare provider for local resources. Sharing experiences can help reduce worry and improve coping skills.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Contact the provider’s office to find out if you need to follow any special instructions before arriving, such as fasting for tests. Making a checklist can help keep things organized.
List all symptoms, especially what happens during an episode, when they began, how long they last, and how often they occur. Note any major life stress, changes, or a family history of ear or balance problems.
Bring a complete list of medications, including all prescription drugs, over-the-counter medicines, vitamins, and supplements, along with their dosages.
It can help to bring a supportive family member or friend. Sometimes it’s hard to remember details during the visit, so another set of ears can help recall what was discussed.
Plan questions to ask the healthcare provider to make the visit more useful. Consider including:
- What is the most likely cause of these symptoms?
- Are there other reasons for these issues?
- Which tests are recommended?
- Is this a short-term condition or will it last long-term?
- What treatment choices are available?
- Are there alternate ways to manage this problem?
- How can other existing health problems be managed together?
- Are there any rules or limits that should be followed?
- Should the patient see a specialist?
Feel free to ask any questions that come up at the visit.
What Your Provider May Discuss or Ask
The healthcare provider usually gathers details to help with diagnosis. The provider may ask questions such as:
- When did the symptoms first start?
- How often do the symptoms occur, and how long do they last?
- How severe are the episodes?
- Are there certain triggers that make symptoms appear?
- What helps make symptoms better or worse?
- Do you or your close relatives have a history of ear problems?
- Have you experienced any hearing changes or problems with balance?
Preparing answers to these questions can help your appointment go more smoothly. This information also helps your provider decide on the next steps.
