Meniere’s Disease
Meniere's disease is an inner ear disorder that can cause a range of symptoms, such as vertigo, tinnitus, fluctuating hearing loss, and a feeling of fullness in the affected ear. Typically, Meniere’s disease affects only one ear, but it can also impact both. Meniere’s disease usually affects individuals between the ages 20 to 50 years old, with no gender predisposition.
The symptoms of Meniere’s disease are usually intermittent, typically lasting for hours to days. Patients may then experience symptom-free periods that can extend for weeks, months, or even years. Common symptoms include:
- Vertigo Attacks – The most common symptom, vertigo, is characterised by a sensation of spinning or dizziness. These episodes can sometimes be severe and disorienting, lasting from 20 minutes to 24 hours. This may also lead to headaches, nausea, and vomiting.
- Tinnitus – This refers to the perception of sound, such as ringing, buzzing, or hissing, when no external sound is present. Tinnitus can be constant or intermittent.
- Hearing Loss – Patients may experience aural fullness in the affected ear, resulting in fluctuating hearing loss, particularly for low-frequency sounds.
- Loss of Balance – Vertigo attacks can lead to balance disturbances and serious falls. These falls are triggered by sudden inner ear imbalances, causing abnormal vestibular reflexes. This results in a sensation of tilting or falling, even while standing upright.
The exact cause of Meniere’s disease remains unknown. However, it is believed to be linked to an imbalance of fluid in the inner ear called the endolymph. This endolymph buildup may result from a combination of factors, including:
- Improper fluid drainage due to a blockage or structural abnormalities in the ear
- Viral infections
- Genetics
- Autoimmune disorders
- Allergies
- Head injury
- Migraine headaches
Your ENT doctor will ask about the frequency, duration, and severity of your symptoms and perform a thorough examination before arriving at a diagnosis. These include:
- Hearing Tests (Audiometry) – This test measures your hearing ability at different frequencies and volumes to assess any hearing loss.
- Balance Tests – Tests like electronystagmogram (ENG) or videonystagmography (VNG) may be used to check the function of one’s vestibular system, which is responsible for balance and spatial orientation.
- Imaging Tests – CT or MRI scans may be used to rule out other conditions that could be causing similar symptoms, such as a brain tumour (although this is rare, its symptoms can be similar).
There is currently no cure for Meniere’s disease. However, treatments are available to manage vertigo attacks and alleviate other symptoms. Treatments include:
- Medications – Medicines may be taken in cases of vertigo attacks:
- Motion Sickness Medicines – These can lessen the spinning sensation and alleviate nausea and vomiting.
- Diuretics – These can help reduce the amount of extra fluid in the ear, potentially alleviating symptoms.
- Betahistine – This may be prescribed to improve blood flow and circulation in the inner ear, helping to manage vertigo attacks.
- Intratympanic injection – This is a steroid injection into one’s middle ear. It is used to improve the fluid balance in the inner ear and can control vertigo in most patients.
- Physiotherapy – Vestibular rehabilitation therapy may be recommended to help manage balance problems.
- Lifestyle Changes – Consuming a low-salt diet can help prevent the body from storing excess water. Reducing alcohol and caffeine intake can also help.
- Hearing Aids – If there is hearing loss, hearing aids may be used.
- Surgery – In severe cases, surgery may be needed. These include:
- Endolymphatic Shunt or Decompression Surgery – This involves creating a shunt or drainage tube to reduce pressure within the inner ear.
- Vestibular Nerve Section – This involves cutting the nerve that transmits balance and movement information from the inner ear to the brain. It aims to reduce vertigo while preserving hearing in the affected ear.
- Labyrinthectomy Surgery – This involves destroying the affected labyrinth, which is the inner ear structure responsible for balance and hearing. While this procedure can very effectively control vertigo, it comes at the expense of hearing loss in the affected ear.
What are the risks and complications of Meniere's Disease?
- While Meniere’s disease is not life-threatening, it can significantly impact one’s quality of life. Sudden, severe vertigo attacks can increase the risk of falls and injuries. Additionally, untreated Meniere’s disease can lead to progressive hearing loss.
Can Meniere's disease improve without medical treatment?
- Meniere’s disease does not typically resolve without treatment. However, symptoms can subside or go into remission for extended periods. However, if left untreated, the disease's underlying issues—such as hearing loss and tinnitus—may persist or worsen and significantly impact quality of life.
Can you live a normal life with Meniere's disease, and what coping strategies can help?
- While Meniere's disease can be unpredictable and disruptive, with proper ENT support, many patients can manage their symptoms relatively well. If you suspect you may have Meniere’s Disease, please reach out to us.
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Mount Elizabeth Medical Centre
Singapore 228510
