What is Meniere's disease?
Named for the French doctor who discovered the disease, Ménière's primarily affects the body's hearing and balance organs, which are closely connected within the inner ear. Excess fluid and pressure in the inner ear leads to these symptoms.
Who gets Meniere's?
Although Meniere's disease can affect people of any age, people in their 40s and 50s are much more likely to experience it. This condition is considered to be chronic and there is no cure, but there are various treatment strategies that will minimize the effect on your life and relieve symptoms. It affects roughly 1 out of every 1,500 people, making it relatively rare. It can affect one or both ears.
What causes Meniere's disease?
People with Meniere's disease most likely have a problem with too much pressure or fluid in their inner, however, doctors still don't know exactly what causes it. It does appear more common among people with head injuries, allergies, respiratory infections, and sleep apnea.
Does it run in families?
About 7-10% of those affected have a family history of the condition, according to the UK nonprofit Meniere's Society.
Potential Meniere's triggers
Basically anything that increases pressure or fluid in the inner ear can trigger an attack. Because the inner ear is so sensitive, this is a long list. However, triggers are different for everyone. Some of these may trigger a Meniere's episode in one person and not another:
Symptoms of Meniere's disease
The four key symptoms:
During an attack, a person's pupils may move rapidly side to side, known as nystagmus (see an example here). People with Meniere's disease also may struggle with "brain fog," or disoriented thinking and fatigue. Rarely, people also experience diplacusis, known as "double hearing."
How often do Meniere's attacks occur?
Symptoms vary from person to person. People with Meniere's will generally experience episodes in clusters with long periods of remission. Some sufferers will experience many attacks over a period of several days, and others will have an isolated attack every once in awhile. In other words, it's highly individual.
How do I know if I'm about to have an attack?
A Meniere's attack usually begins with the feeling of pressure in the ear, followed by tinnitus, hearing loss and vertigo. These episodes will last anywhere from 20 minutes to four hours.
How do I make it go away?
When you experience an episode of Meniere's disease, it is best to lie down and focus on one non-moving object, as this helps your inner ear rest. A nap may help, too. Any rescue medications you've been prescribed also may help, such as anti-nausea medication and anti-anxiety medication.
Long-term, people with this condition generally have it for life.
How is Meniere's disease diagnosed?
Repeated bouts of tinnitus, hearing loss and vertigo are strong indicators of Meniere's disease. Still, since all of these issues are common and can be associated with other diseases, Meniere's can sometimes be difficult to diagnose.
"It is important to acknowledge that a full and accurate diagnosis may take many months to attain," write the authors of clinical practice guidelines published in the April 2020 issue of the Journal of Otolaryngology–Head and Neck Surgery.
Tests your doctor may order for Meniere's disease
There is no single test to detect and diagnose Meniere's disease. Testing can help rule out other conditions, though.
Tests may include:
Similar health conditions
To confirm a diagnosis of Meniere's disease, doctors need to rule out other diseases that cause similar symptoms, note the guideline authors. These include autoimmune inner ear disease (a common cause of sudden hearing loss), otosclerosis, acoustic neuromas, temporal bone fracture, otosyphilis, vestibular neuritis, vestibular migraines and acute labyrinthitis. These diseases generally respond to different treatment.
If your only primary symptom is vertigo, it may not be Meniere's but instead a common condition known as BPPV.
Also, if you're having trouble sleeping or experiencing an increase in daytime sleepiness, you may want to get evaluated for obstructive sleep apnea. About 15% of people with Meniere's also have sleep apnea.
Stages of Meniere's disease and diagnosis
Meniere's disease commonly affects people in various stages, with symptoms developing over time.
What is a drop attack?
In rare cases, people with late-stage Meniere's disease may feel off balance and suddenly fall down but remain conscious and aware of what is happening. This is called a drop attack. It can be very scary to experience a drop attack, and your doctor should be notified if you are experiencing them. In and of themselves they are not harmful, but they can lead to serious injuries. The website Dizziness and Balance has an in-depth page on drop attacks.
Tinnitus and Meniere's disease
Many people who have frequent or constant ringing in the ears understandably hope there is treatment to make it go away. While there is typically no cure, tinnitus can be managed successfully, especially if you are careful about disease triggers and reduce your noise exposure.
Hearing loss with Meniere's disease
Meniere's disease can cause hearing loss, including mid- and low-frequency hearing loss, meaning low-pitched sounds may be harder to hear (men's voices compared to women's voices, or the bass in music, for example). A person also might be more sensitive to higher-pitched sounds and find them uncomfortable, known as hyperacusis.
However, Meniere's disease is unpredictable and the hearing loss may not affect low frequencies, but instead high frequencies. Often the hearing loss comes and goes, making it harder to diagnose.
Some people will gradually develop more serious levels of hearing loss, which may be only in one ear or both ears. Hearing loss in one ear causes unique problems but can be treated.
The hearing loss can range from mild to profound.
Treating hearing loss from Meniere's
How Meniere's affects mood and emotions
Along with the common symptoms of Meniere's disease, it's possible to suffer from depression or anxiety. About half of all Meniere's patients have depression, according to a 2020 systematic review that looked at the two conditions.
This isn't surprising: Since the ailment affects hearing, you may develop fear and lose confidence to have conversations with others or at work, which can contribute to depression or anxiety. In addition, dizziness symptoms tend to pop up out of nowhere, so those living with Meniere's can be in a constant anxious state, unsure of when an episode will occur.
The good news: There are ways to face the fear of living with Meniere's and tinnitus.
Meniere's vs BPPV
Is Meniere's disease related to benign paroxysmal positional vertigo (BPPV?) No, although both disorders are associated with vertigo, they are not usually related. However, it is possible to have both disorders at the same time.
Remedies and relief strategies for Meniere's
A variety of at-home remedies may help control Meniere's, although none of them have been studied extensively to know if they're effective or not.
Meniere's diet recommendations
Dietary changes may decrease the amount of fluid in the inner ear, which can weaken the symptoms of the disease. Researchers looking at this issue concluded there aren't any good clinical trials on diet and Meniere's disease. The good news? These changes are worth trying because they aren't harmful and may improve your overall health:
Other lifestyle changes that can help with Meniere's
Medical treatments for Meniere's
Unfortunately, many of the treatments for Meniere's haven't been studied extensively. The Cochrane Collaboration, which evaluates medical research, found only two treatments had any clinical trial evidence to support their use. Those are:
For either treatment, though, more study is needed to know how effective they are, researchers concluded.
Other treatments for Meniere's
Other treatment options that have been less studied specifically for Meniere's include:
There are plenty of other suggested Meniere's treatment options, but evidence is lacking for their use. This doesn't necessarily mean they won't work, they just haven't been studied. According to the National Institutes of Health, these treatments include cognitive-behavioral therapy, pressure pulse treatment, acupuncture and other alternative therapies.
Note: For an in-depth medical overview of Meniere's we recommend this page maintained by doctors with the Chicago Dizziness and Hearing clinic.
Who treats Meniere's?
Generally ear, nose and throat doctors, known as ENTs, or otolaryngologists, treat inner ear disorders. Neurologists and audiologists also may be on your healthcare team. If you experience symptoms of tinnitus, hearing loss and dizziness, see your primary care doctor for a referral to an ENT physician or visit a hearing center near you. Always seek help right away if you experience sudden hearing loss.