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Other Names:
Hydrops, Endolymphatic Hydrops
Ménière's Disease

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Ménière's disease, an abnormality of the inner ear, is a common cause of hearing loss. Symptoms include:

  • vertigo or dizziness,
  • tinnitus,
  • fluctuating hearing loss, and
  • ear pressure or pain.

What's causing it?

The symptoms of Ménière's disease are associated with a change in the fluid volume of your inner ear. Extra fluid in your inner ear can cause swelling. Experts believe that this swelling can rupture membranes in your inner ear, causing one fluid in your inner ear to mix with another fluid. The mixing of fluids may cause the symptoms of Ménière's disease.

Other possible causes of the disease include what are called 'environmental factors,' such as noise pollution and viral infections, and biological factors.

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What will the doctor do?

To diagnose Ménière's disease, doctors use several procedures:

  • a medical history interview and physical examination,
  • hearing and balance tests, and
  • magnetic resonance imaging (MRI), a sophisticated technique that takes detailed pictures of the inside of the body.

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Treatment

There is no known cure for Ménière's disease, but your doctor can suggest methods to control its symptoms, such as a change in diet or medicine. For patients with persistent, debilitating vertigo, doctors have successfully used surgery and an antibiotic to treat Ménière's disease.

Your own voice may sound too loud. Your audiologist may or may not be able to correct this problem. Most people get used to it over time.

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What causes Ménière's disease?

The symptoms of Ménière's disease are associated with a change in fluid volume within a portion of the inner ear known as the labyrinth. The labyrinth has two parts: the bony labyrinth and the membranous labyrinth. The membranous labyrinth, which is encased by bone, is necessary for hearing and balance and is filled with a fluid called endolymph. When your head moves, endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion. An increase in endolymph, however, can cause the membranous labyrinth to balloon or dilate, a condition known as endolymphatic hydrops.

Many experts on Ménière's disease think that a rupture of the membranous labyrinth allows the endolymph to mix with perilymph, another inner ear fluid that occupies the space between the membranous labyrinth and the bony inner ear. This mixing, scientists believe, can cause the symptoms of Ménière's disease. Scientists are investigating several possible causes of the disease, including environmental factors, such as noise pollution and viral infections, as well as biological factors.

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What are the symptoms of Ménière's disease?

The symptoms of Ménière's disease occur suddenly and can arise daily or as infrequently as once a year. Vertigo, often the most debilitating symptom of Ménière's disease, typically involves a whirling dizziness that forces the sufferer to lie down. Vertigo attacks can lead to severe nausea, vomiting, and sweating and often come with little or no warning.

Some individuals with Ménière's disease have attacks that start with tinnitus (ear noises), a loss of hearing, or a full feeling or pressure in the affected ear. It is important to remember that all of these symptoms are unpredictable. Typically, the attack is characterized by a combination of vertigo, tinnitus, and hearing loss lasting several hours. People experience these discomforts at varying frequencies, durations, and intensities. Some may feel slight vertigo a few times a year. Others may be occasionally disturbed by intense, uncontrollable tinnitus while sleeping. Ménière's disease sufferers may also notice a hearing loss and feel unsteady all day long for prolonged periods. Other occasional symptoms of Ménière's disease include headaches, abdominal discomfort, and diarrhea. A person's hearing tends to recover between attacks but over time becomes worse.

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How is Ménière's disease diagnosed?

Based on a recent study, NIDCD estimates that there are currently approximately 615,000 individuals with diagnosed Ménière's disease in the United States and 45,500 newly diagnosed cases each year. Proper diagnosis of Ménière's disease entails several procedures, including a medical history interview and a physical examination by a physician, hearing and balance tests, and medical imaging with magnetic resonance imaging (MRI). Accurate measurement and characterization of hearing loss are of critical importance in the diagnosis of Ménière's disease.

Through the use of several types of hearing tests, physicians can characterize hearing loss as being sensory, arising from the inner ear, or neural, arising from the hearing nerve. Recording the auditory brain stem response, which measures electrical activity in the hearing nerve and brain stem, is useful in differentiating between these two types of hearing loss. Electrocochleography, recording the electrical activity of the inner ear in response to sound, helps confirm the diagnosis.

To test the vestibular or balance system, physicians irrigate the ears with warm and cool water or air. This procedure, known as caloric testing, results in nystagmus, rapid eye movements that can help a physician analyze a balance disorder. Since tumor growth can produce symptoms similar to Ménière's disease, an MRI is a useful test to determine whether a tumor is causing the patient's vertigo and hearing loss.

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How is Ménière's disease treated?

There is no cure for Ménière's disease. However, the symptoms of the disease are often controlled successfully by reducing the body’s retention of fluids through dietary changes (such as a low-salt or salt-free diet and no caffeine or alcohol) or medication. Changes in medications that either control allergies or improve blood circulation in the inner ear may help. Eliminating tobacco use and reducing stress levels are more ways some people can lessen the severity of their symptoms.

Different surgical procedures have been advocated for patients with persistent, debilitating vertigo from Ménière's disease. Labyrinthectomy (removal of the inner ear sense organ) can effectively control vertigo, but sacrifices hearing and is reserved for patients with nonfunctional hearing in the affected ear. Vestibular neurectomy, selectively severing a nerve from the affected inner ear organ, usually controls the vertigo while preserving hearing, but carries surgical risks. Recently, the administration of the ototoxic antibiotic, gentamycin directly into the middle ear space has gained popularity worldwide for the control of the vertigo of Ménière's disease.

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What research is being done?

Scientists are investigating environmental and biological factors that may cause Ménière's disease or induce an attack. They are also studying how fluid composition and movement in the labyrinth affect hearing and balance. By studying hair cells in the inner ear, which are responsible for proper hearing and balance, scientists are learning how the ear converts the mechanical energy of sound waves and motion into nerve impulses. Insights into the mechanisms of Ménière's disease will enable scientists to develop preventive strategies and more effective treatment.

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Where can I get additional information?

American Academy of Otolaryngology-Head and Neck Surgery

Deafness Research Foundation

Ear Foundation

Vestibular Disorders Association

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Meniere's Disease