Recurrent attacks of vertigo with ringing and ringing in the ears and hearing loss are often linked to Meniere’s syndrome.
What is this disease? What are its causes and complications?
The answers to your questions can be found in this sheet.
What is Meniere’s disease?
Meniere’s disease (or Meniere’s syndrome) is characterized by recurrent attacks of vertigo that are accompanied by ringing and ringing in the ears (tinnitus) and hearing loss. Most often, only one ear is affected.
It is a chronic disease. The frequency of seizures is highly variable and unpredictable. Most sufferers have a few seizures a year, but some have several a week. Between seizures, periods of remission can last several months or even years. There is no cure for Meniere’s disease, but symptoms can be relieved effectively in most cases.
Meniere’s disease was first described in 1861 by a French physician, Dr. Prosper Ménière, after whom it is named.
Meniere’s disease: who is affected?
Meniere’s disease most often appears around the age of 40 to 601, although cases have been described in children. It affects slightly more women than men. In Europe and North America, prevalence ranges from 1 in 1,000 to 1 in 10,000, depending on the study.
Causes of Meniere’s disease
The cause of Meniere’s disease remains unknown. It is a disease affecting the inner ear, the deepest part of the ear that provides hearing and balance. The organ of hearing, which is shaped like a snail, is called the cochlea (or slug). The organ of balance is called the vestibule (see diagram above). The cochlea and vestibule are filled with a fluid, the endolymph.
The symptoms of Meniere’s disease are thought to be caused by an excess of endolymph in the inner ear, referred to as endolymphatic hydrops. Excess endolymph increases pressure in the inner ear, which prevents sounds from being perceived correctly and scrambles balance signals sent to the brain.
Thus, during an attack of vertigo, contradictory information reaches the brain, as if the body is both stopped and moving.
Scientists don’t know what causes the increased pressure in the inner ear. Several hypotheses have been made:
- reaction to a head injury or certain infections;
- a food allergy or intolerance;
- dysregulation of the immune system (an autoimmune mechanism).
For the moment, none of these hypotheses have been formally validated.
Meniere’s disease: what evolution?
The disease is manifested by unpredictable seizures that vary in frequency. In the first years of the disease, attacks of vertigo tend to intensify. Then, over time (from 5 to 10 years), they become rarer and their intensity gradually diminishes.
At first, only one ear is usually affected, but nearly half of people have symptoms in both ears after a few years.
Often, at the beginning of the disease, a series of seizures occurs over a short period of time, ranging from a few weeks to a few months. The seizures may then disappear for several months or become spaced out.
Symptoms of a seizure
In general, symptoms last from 20 minutes to 24 hours and lead to great physical exhaustion.
Here are the symptoms:
- a feeling of fullness in the ear and intense tinnitus (whistling, ringing), which often occurs first;
- Intense and sudden vertigo, which forces you to go to bed. You may feel like everything revolves around you, or that you turn yourself;
- partial and fluctuating hearing loss
- dizziness and loss of balance
- rapid, uncontrollable eye movements (nystagmus, in medical language);
- sometimes nausea, vomiting, and sweating;
- sometimes stomach aches and diarrhea;
- In some cases, the patient feels “pushed” and falls suddenly. This is called Tumarkin seizures or otolithic seizures. These falls are dangerous because of the risk of injury.
Attacks of vertigo are sometimes preceded by a few warning signs, but they most often occur suddenly:
- a feeling of the blocked ear, as occurs at high altitudes;
- partial hearing loss with or without tinnitus;
- a headache
- sensitivity to sounds;
- a loss of balance.
- In some people, tinnitus and balance problems persist;
- At first, hearing usually returns to normal between seizures. But very often a permanent hearing loss (partial or total) sets in over the years.
Do you know who people are and what risk factors for Meniere’s disease are?
Discover the answers to your questions in detail in this article.
Meniere’s disease: people at risk
People who have a family member with Meniere’s disease. There is indeed a genetic predisposition to the disease. Some studies indicate that up to 20% of family members may have the disease.
Origins of Northern Europe
People from Northern Europe and their descendants are more prone to Meniere’s disease than people of African descent.
They are up to 3 times more affected than men.
Meniere’s disease: risk factors
No risk factors for this disease are known, but it appears that the following may trigger attacks of vertigo in people with the disease:
- a period of high emotional stress;
- severe fatigue;
- changes in barometric pressure (in the mountains, by plane, etc.);
- the ingestion of certain foods, such as those that are very salty or contain caffeine.
Prevention of Meniere’s disease is done through medication, diet, and other effective preventive measures.
Discover them in full in this article.
Meniere’s disease: how to prevent it?
Can we prevent it?
Since the cause of Meniere’s disease is not known, there is currently no way to prevent it.
Measures to reduce the intensity and number of seizures
Some medications prescribed by the doctor can reduce pressure in the inner ear. These include diuretic drugs, which cause increased elimination of fluids through the urine. Examples include furosemide, amiloride and hydrochlorothiazide (Diazide®).
It seems that the combination of diuretic drugs and a low-salt diet (see below) is often effective in reducing dizziness. However, it would have less effect on hearing loss and tinnitus.
Vasodilator drugs, which increase the opening of blood vessels, are sometimes helpful, such as betahistine (Serc® in Canada, Lectil in France). Betahistine is widely used in people with Meniere’s disease because it acts specifically on the cochlea and is effective against dizziness.
Note: People who are treated with diuretics lose water and minerals, such as potassium. At the Mayo Clinic, it is recommended that you include potassium-rich foods, such as cantaloupe, orange juice, and bananas, which are good sources of potassium. See the Potassium fact sheet for more information.
Very few clinical studies have measured the effectiveness of the following measures in preventing attacks and reducing their intensity. However, according to the testimonies of doctors and people with the disease, they seem to be of great help for several reasons: Eat a low-salt (sodium) diet: Foods and beverages high in salt can vary the pressure in the ears, as they contribute to water retention.
It is suggested to aim for a daily intake of 1,000 mg to 2,000 mg of salt. To achieve this, do not add salt to the table and avoid prepared dishes (soups in bags, sauces, etc.).
Avoid eating foods that contain monosodium glutamate (MSG), another source of salt. Prepackaged foods and some foods from Chinese cuisine are more likely to contain them. Read labels carefully.
Avoid caffeine, which is found in chocolate, coffee, tea, and some soft drinks. The stimulating effect of caffeine can worsen symptoms, especially tinnitus.
Also, limit sugar intake. According to some sources, a diet high in sugar would have an impact on the fluids of the inner ear.
Eating and drinking regularly help regulate body fluids. At the Mayo Clinic, it is recommended to eat about the same amount of food at each meal. The same goes for snacks.
Try to reduce stress, as this would be a trigger for seizures. Emotional stress would increase the risk of seizure in the hours that follow.
In case of allergies, avoid allergens or treat them with antihistamines; Allergies could make symptoms worse. Some studies have shown that immunotherapy can reduce the intensity and frequency of seizures by 60% in people with Meniere’s disease who have allergies.
It is also strongly advised not to smoke.
Keep lighting important during the day, and light lighting at night to facilitate visual cues to prevent falls.
Avoid taking the aspirin unless otherwise advised by your doctor, as aspirin can trigger tinnitus. Also, seek advice before taking anti-inflammatory drugs.
There is no cure for Meniere’s disease. However, some medications are necessary for prevention.
Check them out below.
How to treat Meniere’s disease?
There is no cure for Meniere’s disease. However, some medications can relieve symptoms during attacks. In addition, some treatments make it possible to space seizures.
Anxiety is often significant in Meniere’s disease. It is linked to the fear of crises, which are unpredictable and often brutal. In addition, tinnitus and persistent balance disorders are very distressing and significantly degrade the quality of life.
For many sufferers, it is important to find support from other patients, associations, or a psychologist. See Support groups. Relaxation and stress management techniques can also be beneficial.
Medication in case of crisis
During an attack, medications for nausea (domperidone, dimenhydrinate: Gravol®) or dizziness (meclizine: Bonamine®, Antivert) can provide temporary relief. They are taken in the form of tablets, or suppositories if the crisis is too great. Anti-anxiety medications (benzodiazepines such as lorazepam, and diazepam) or nausea medications (prochlorperazine, promethazine, Phenergan) can also calm seizure symptoms.
The purpose of background treatment is to reduce the frequency of vertigo attacks. It is not systematic and its effectiveness is variable. Unfortunately, no treatment has been shown to be effective in all sufferers.
Diuretic and vasodilator medications, obtained by prescription, may be beneficial. See Prevention.
The doctor sometimes injects medication into the affected inner ear, through the eardrum. It may be an antibiotic, usually gentamicin. This product destroys the tissues of the inner ear. Thus, the brain no longer receives contradictory balance signals, the very ones that cause dizziness.
Several injections are sometimes required, depending on the response to treatment. There may be an initial period of imbalance. Due to the toxicity of the antibiotic, the risk of hearing deterioration in the treated ear is about 20%. This irreversible treatment is reserved for people who have very disabling symptoms.
Corticosteroids, such as dexamethasone, may also be injected to try to space seizures or reduce dizziness and tinnitus that is resistant to other treatments. Unlike gentamicin, they are not toxic to cells. In some cases, corticosteroids are also used during seizures, either orally or intramuscularly (injections).
A device called a low-pressure pulse generator (Meniett®) may be effective in some people. It is a device that is affixed to the entrance of the ear and emits pulses at low frequencies.
These pulses would facilitate the evacuation of excess fluid in the inner ear. Most often, 3 sessions of 5 minutes a day are prescribed to control refractory vertigo. This device is relatively effective and has the advantage of not being invasive.
If dizziness persists between seizures, it may be helpful to have vestibular rehabilitation sessions with a physiotherapist or occupational therapist. These sessions make it possible to compensate for the malfunction of the inner ear and vestibule (which controls balance) through various exercises (with a rotating chair, special glasses, etc.).
The physiotherapist can teach exercises to do at home that will allow you to relearn how to keep balance. The exercises mainly consist of making head and body movements to correct the feeling of loss of balance. They train the brain to use different visual and proprioceptive cues to maintain balance and gait.
When hearing loss is severe, hearing aids can help you hear better. They are sometimes difficult to adapt to because hearing loss is often fluctuating in people with Meniere’s disease. Consult a hearing care professional.
When other treatments do not work and the disease is very disabling, surgery may be proposed. Surgery is usually reserved for refractory and severe cases, as it can result in hearing loss in the treated ear.
Decompression of the endolymphatic sac
Under general anesthesia, the layer of bone around the endolymphatic sac, the part of the inner ear that contains fluids (the endolymph), is removed to allow excess fluid to drain. This surgery is performed on the back of the ear.
In about 1 in 2 people, it reduces dizziness by at least half in the short term. The longer-term results are much worse. However, the procedure carries a slight risk of hearing loss, in addition to the usual complications associated with general anesthesia.
Vestibular nerve section
During this operation, the vestibular nerve, which is used to send balance signals from the inner ear to the brain, is severed. Thus, it no longer sends uninterpretable signals to the brain. This operation, effective in eliminating dizziness, exposes the patient to permanent hearing loss. It is therefore rarely used and is reserved for extreme cases. It is also called vestibular neurotomy.
This procedure consists of completely destroying the sensory components of the inner ear (the labyrinth). It is the most effective in treating dizziness but leads to complete and irreversible hearing loss. Labyrinthectomy is sometimes considered in cases where antibiotic injections have proven ineffective, or when auditory functions are already very poor and tinnitus and dizziness are very distressing.
Tips during a crisis:
- Sit or relax;
- fix the gaze on an object;
- move the head as little as possible, because even small movements accentuate the symptoms;
- avoid bright light;
- do not ingest anything as long as nausea persists;
- Favor silence. The sounds of television and radio become irritating;
- do not read while symptoms persist;
- stay calm and rest as long as symptoms are present;
- Once the crisis is over, note the symptoms to better describe them to your doctor.
Image Credit: Image by stefamerpik on Freepik