Meniere’s disease is associated with an increased level of fluid, called endolymph, within the inner ear. The increased endolymph, within the semi-circular canals and cochlear, causes an increased pressure in these areas of the ear which are concerned with both balance and hearing, respectively. The technical term for Meniere’s is “idiopathic endolymphatic hydrops”, where idiopathic refers to a disease that arises spontaneously with no known cause.
The increased pressure can cause problems with the sensory information for hearing and balance, which in turn causes symptoms such as fullness of the ear, tinnitus, hearing loss and vertigo. Symptoms are often fluctuating and recurring, and although they can occur at any age, are more likely to happen to adults between 40-60 years old.
It is thought that the large amounts of endolymph fluid in the ear may cause disruption of the membrane which contains the fluid, allowing potassium to enter and disrupt transmission of sensory information from the ear to the brain. Some people will report that attacks can be triggered by events such as a certain stress, fatigue, pressure change or increased salt in the diet.
Typically, Meniere’s disease sufferers will have acute attacks, whereby they will feel violent, spontaneous vertigo, hearing loss, aural (ear) fullness and tinnitus. Before attacks there may be some warning signs such as headaches, increasing tinnitus and ear fullness, and attacks may continue for 20 minutes up to 24 hours, with ongoing fatigue and balance disorders continuing for longer.
The frequency of attacks may vary from several per week, to monthly, yearly or even less. Between attacks, some people have no symptoms at all but as the disease progresses, many will have ongoing aural fullness, tinnitus and permanent hearing loss, with vertigo attacks being replaced by constant struggles with balance and vision.
Therapy for Meniere’s disease ranges from conservative to aggressive. Vestibular therapy, between attacks, is aimed at improving the coping strategies of the brain to ensure that function is maintained. By training balance and head-eye coordination, the patient can feel confident that the brain is not only better able to recover from attacks but is also less likely to suffer progressively worsening function as the disease progresses.
Conservative measures also involve certain dietary guidelines, which include:
Aggressive treatment may include the use of gentamicin injections to destroys vestibular tissue in the inner ear, and in some cases, surgery. Surgery can be aimed at relieving the pressure of the inner ear or completely blocking the transmission of information from the ear to the brain. Fortunately, the brain can still cope when one vestibular system is absent, by relying on the other ear, as well as the other senses of vision and proprioception!
