What is Ménière’s disease?
Ménières disease is a disorder of the inner ear that manifests as episodes of vertigo (dizzziness), sensorineural hearing loss, and tinnitus (ringing in the ear). The symptoms are typically unilateral and fluctuate in severity lasting anywhere from minutes to hours, but may involve both ears.
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Causes
Although the exact cause of Ménière’s disease is not always well known, increased pressure in the inner ear, called hydrops, may be related to immune disorders, electrolyte balance in the inner ear, migraine, chronic inflamation, or allergy. Therefore a appropriate assesment is necessary for providing the most appropriate management options.
Symptoms
The symptoms of Ménière’s disease can vary but commonly include:
- spinning sensation or dizziness (vertigo)
- fluctuating hearing loss
- ringing in the ear (tinnitus)
- pressure/fullness of the ear
It may also be associated with nausea, vomiting, and headaches.
Treatment
Ménière’s disease can be managed conservatively with lifestyle changes. These changes include maintaining salt intake at 1500 – 2000 mg per day and spreading the intake evenly throughout the day. This avoids large changes in salt in the body. Maintaining appropriate water intake per day can also be beneficial at decreasing the frequency and severity of symptoms. Managing stress is also important, as stress can increase Ménières symptoms frequency and severity.
Patients may be asked to maintain a food log to understand any foods that increase symptoms by intolerance or allergy. Diuretic medication may be helpful in managing symptoms. For those with severe symptoms, an intratympanic injection of dexamethasone (steroid) into the middle ear can be an effective measure to alleviate symptoms. Migraine medication can be effective at managing symptoms refractory to lifestyle modification in conjunction with the lifestyle changes above.
Surgery
Although very rare, for those with severe and debilitating symptoms that don’t respond to conservative and medical management, surgery may be an option. Endolymphatic sac surgery might be a good option as it is not a destructive procedure (labyrinthectomy or gentamicin) and can help to preserve inner ear function as shown in our publication. Ménières can become bilateral so it is important to not be destructive with treatment.
Adrien A. Eshraghi, MD, MSc, FACS 