Meniere's Disease

At a glance

Symptoms: Vertigo attacks with fluctuating hearing loss, tinnitus, and ear fullness
Common causes: Excess inner ear fluid (endolymphatic hydrops); often linked with migraine
How it's diagnosed: Hearing tests, vestibular testing, and imaging to exclude other causes
Treatment: Salt restriction, diuretics, migraine management, and targeted therapies

Overview

Meniere’s Disease, or Idiopathic Endolymphatic Hydrops, presents a unique set of challenges and requires specialized care. Our clinic offers expert management for patients suffering from Meniere’s Disease, utilizing the latest in diagnostic and treatment methodologies to offer relief and improve quality of life.

Diagnosis

Our approach begins with a comprehensive clinical evaluation to accurately diagnose Meniere’s Disease, leveraging:

Detailed Audiometry: To track hearing loss variations over time.
Infrared Video Oculography: For identifying nystagmus during vertigo attacks, indicative of Meniere’s Disease.
Vestibular Testing, Blood Work, and Imaging: Including MRI and CT scans to exclude other causes of symptoms.

Treatment

Understanding that there is currently no cure for MD, our clinic focuses on:

Reducing Attack Frequency and Duration: Through lifestyle modifications and avoidance of dietary triggers.
Pharmacologic Therapy: Beginning with diuretics to manage fluid pressure in the inner ear, and Betahistine to act on central nervous system histamine receptors.
Migraine and Meniere’s Disease Management: Given the linkage between Meniere’s Disease and migraine, we employ a dual approach that includes migraine preventative and abortive medications, in addition to dietary and lifestyle adjustments.

At our clinic

Concomitant Treatment for Meniere’s and Migraine: Reflecting on the historical and clinical connections between Meniere’s Disease and migraines, our clinic adopts a unique treatment strategy that addresses both conditions simultaneously, aiming to reduce the frequency of Meniere’s attacks and mitigate migraine symptoms.
Educating Patients: We believe in empowering our patients with knowledge about their condition, encouraging active participation in the management of their health.

Audiogram Insights

Our clinic utilizes audiograms to monitor the progression of Meniere’s Disease, offering insights into:

Normal Hearing vs. Presbyacusis: Age-related hearing loss and its progression.

Meniere’s Episode and Late Stage: The impact of Meniere’s Disease on hearing over time.

Migraine Variant: Understanding episodic hearing loss associated with migraines.

Audiogram examples

**Normal Hearing**This audiogram depicts normal hearing function in both the right and left ear and all frequencies.

**Presbyacusis**Prebysacusis refers to age related hearing loss that gradually affects most individuals starting in their 60's. About 30-35% of people aged 65 or older have age related hearing loss. In this audiogram, the same individual was given a hearing test at age 66 and again at age 82. In prebycusis, it is common for hearing to decline most in the higher frequencies.

**Meniere's Episode**This is audiogram from a patient's suffering from a Meniere's attack on the left ear. During the Meniere's episode, low frequency hearing will be affected and the patient may also reports symptoms of tinnitus or aural fullness. An audiogram taken after an episode may show improvement in hearing function, however over time the patient's hearing would be expected to decline.

**Meniere's Disease Late Stage**In the late stages of Meniere's disease, the affected ear will likely have permanent sensorineural hearing loss due to repetitive damage.

**Migraine Variant**This audiogram represents possible high frequent hearing loss that may be seen in a migraine variant syndrome. It is episodic and hearing should resume to normal after the migraine resolves.

Living with Meniere's Disease

We are committed to supporting our patients through every phase of Meniere’s Disease, providing personalized care plans that include dietary recommendations, medication management, and strategies for coping with acute attacks.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

Videonystagmography (VNG)A comprehensive eye-movement test battery used to evaluate vestibular and oculomotor function.

Vestibular Evoked Myogenic Potentials (VEMP)Measures reflex responses from the otolith organs (saccule and utricle) to sound or vibration.

DizzyDoctor Vertigo Recording GogglesHigh-resolution infrared video goggles used to document eye movements during dizziness and positional vertigo evaluation.

Specialty care: Meniere’s DiseaseMeniere's Disease is a disorder of the inner ear causing severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or…TinnitusTinnitus is ringing, buzzing, or other sound in the ears with no outside source. It often accompanies hearing loss and can be managed even when it can't be cured.Vestibular MigraineVestibular migraine is a common cause of recurrent vertigo, in which migraine affects the balance system, with or without a headache.Migraine and Meniere's: is there a link? (PDF)

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

Weakness or numbness of the face, arm, or leg, especially on one side
Trouble speaking or understanding speech
Double vision or sudden loss of vision
A sudden, severe headache
Inability to walk or stand
Chest pain, fainting, or a seizure