Menieres disease describes a condition that produces episodes of spinning dizziness (rotational vertigo). To diagnose Menieres disease, there should be:
- Spinning dizziness (rotational vertigo)
- Hearing loss
- Ringing in the ear (tinnitus)
Patients also often describe a fourth symptom, which is a fullness in the ear (aural fullness). The feeling is likened to plugging the ear with cotton wool.
In the past many patients were diagnosed with Menieres disease that probably had Vertiginous Migraine – which can present with some similar symptoms (see Vertiginous Migraine page).
The dizzy episodes in Menieres disease come on suddenly and last up to 24 hours. The tinnitus and hearing loss may accompany the dizziness or precede it. Patients are acutely unwell and describe profuse vomiting sometimes with diarrohoea.
Between episodes most patients function normally. With time however hearing, which usually improves again after the dizzy episode, gradually gets worse. Episodes may be very sporadic or occur in clusters over the course of a few weeks. In many patients the dizzy episodes fade until they eventually cease. These patients are often described by balance specialists as having ‘burnt-out Menieres’. Unfortunately there may have been a severe permanent hearing loss by the time the disease reaches this stage.
Around 25% of Menieres patients will eventually get the disease in the second ear.
Diagnosis is based upon the patient’s history together with the findings on examination and testing hearing(audiometry). Blood tests and an MRI scan may also be required. A hearing test will often show a typical low frequency so-called ‘sensorineural’ hearing loss – meaning the hearing receptors are not functioning well.
Treatment is designed to reduce both the severity and frequency of the dizzy spells.
Management of Menieres Disease
Patients are firstly advised to cut out salt from their diet and a level of 2 grams of salt a day is usually given as the upper limit of intake.
They may also be given various types of medications, which are designed to reduce the fluid volume fluctuations in the inner ear thought to cause this condition.
For acute episodes of dizziness a drug to reduce the abnormal messages from the ear to the brain is used. This is called a vestibular sedative but should only be used during the period of the acute attack. The commonest drug used for this is prochlorperazine and is best used in the form absorbed when placed in the cheek (buccastem).
If medication fails to work there are surgical options. These are used depending upon the severity of the condition.
A small tube inserted in the eardrum which equalizes air pressure. This is often very effective.
A Meniett Device
Placed in the ear when a grommet is present, this device provides relief from Menieres for many patients who have not responded to a grommet alone.
Transtympanic Dexamethasone Perfusion of the Inner Ear
A long needle is placed through the ear drum under microscopic control following application of a local anaesthetic. A steroid is injected and the patient is asked not to swallow for 30 minutes. This gives enough time for the steroid to enter the inner ear. This can be performed in the outpatient clinic and may require 3-5 repeat injections.
Endolymphatic sac decompression
This procedure requires a general anaesthetic (the patient is asleep). The endolymphatic sac is reached by drilling into the bone behind the ear. Once the sac is reached it can be decompressed or removed to provide relief from Menieres disease. There is a small risk of hearing loss.
Transtympanic Gentamicin Application to the Vestibular Apparatus.
This uses exactly the same technique as the dexamethasone injection. In this case however Gentamicin is given which is toxic to the inner ear. The dosage has to be carefully controlled to partly damage the inner ear balance organ without also damaging hearing. If successful the balance organ is partly destroyed thus stopping the dizzy spells and hearing is maintained. On occasions the injection needs to be given more than once before control of symptoms is achieved. As 25% of patients will eventually get Menieres in the other ear, patients have to be carefully counseled before undergoing this procedure.