4 questions to consider if you’ve been told your vertigo is from Meniere’s disease.

Meniere’s disease is an inner ear disorder that can give people spontaneous and often severe attacks of hearing disturbance and vertigo.  Although the exact cause is unknown, it is generally accepted that the symptoms result from an abnormal build-up in pressure from the fluid in the inner ear (the endolymph) that can eventually rupture the organ’s membrane.

This rupture allows fluids to mix that shouldn’t. The cause of Ménière’s disease is unknown, although theories include an autoimmune reaction, a genetic connection, circulation problems, migraine, and viral infection. 

Symptoms

Symptoms of a Ménière’s disease attack often differ from one person to the next and where one is in the course of the disease.  Often the first hint that an attack is coming is a sense of one-sided ear fullness and some sort of hearing disturbance like fluctuation in hearing or tinnitus. As the attack progresses, in addition to the hearing loss/disturbance there is typically the onset of violent vertigo, unsteadiness, nausea and vomiting.  Unfortunately, it is not uncommon for people to be misdiagnosed with Meniere’s disease as there is no definitive test for it, and other conditions have similar symptoms.  

This diagnosis should come from a Neuro-otologist or Ear, Nose, Throat (ENT) specialist with a specific focus on vestibular disorders in their practice.  

Do you experience these symptoms?

• Have you only had ONE attack so far?  If you’ve only had one attack, while it could be the start of Meniere’s disease, it is far more likely that you had something like an inner ear infection and you should not be given this diagnosis unless you have had multiple attacks.Do you have absolutely no disturbance in hearing during these attacks and have not experienced hearing loss?  
• In the early stages hearing may return to normal between attacks, but after repeated attacks people typically develop a progressive sensori-neural hearing loss (more commonly affecting the lower frequencies).  A person may have vertigo without the hearing disturbances in some forms of Meniere’s disease, but this is very rare.  When there are no hearing-related symptoms, your doctor should consider migraine – see #4 below.
• Does the vertigo during your attacks only last for a few minutes at a time and can you ‘turn it on or off’ by changing your position? Normally the vertigo that comes with a Meniere’s attack is constant no matter what you try and lasts for at least 20 minutes but typically hours. The whole attack should be over in less than 24 hours.
• Do you have any of the following with your attacks? Sensitivity to light and/or sound, where you have to go into a darkened, quiet place? Bright sparkling lights or zigzag lines in your vision, or an area that seems to be altered or missing (visual aura)? Headache? Some people who are thought to have Ménière’s disease actually turn out to have a form of migraine.  

Many of the symptoms can be very similar, hence the frequent misdiagnosis, and migraine are  at least five times more common than Ménière’s.  You do not necessarily even have to have a headache for it to be a vestibular migraine.  

If you do have a headache or head pressure with your attacks, especially if you also have some of the other characteristics described above, or a history of motions sickness or migraine, be sure to let your healthcare providers know.

To make matters more confusing, it appears that it is not uncommon for people to have both Meniere’s and migraine (with or without headache), so while Meniere’s may have been the correct diagnosis originally, your current symptoms could be from migraine, and thus require an entirely different treatment!  See our blog on vestibular migraine

Treatment

Unfortunately, there is no “cure” for Ménière’s disease.  Some people with Ménière’s disease return to feeling 100% better between attacks (other than  a progressive hearing loss ) and others have residual symptoms of dizziness and unsteadiness. Treatment options range from conservative to surgical and all the options should be discussed with your ENT Specialist or Neuro-otologist.  

Vestibular rehabilitation is among the treatment options and while it shouldn’t be expected to cure or prevent the attacks, it can be helpful in a number of ways:

• Education to help understand the condition.
• Dietary and lifestyle changes that might reduce the frequency of the attacks.
• Techniques that can help reduce the dizziness and unsteadiness that linger BETWEEN attacks.  (This approach is most appropriate if your attacks are less than four weeks apart.)
• Helping your brain compensate to the more stable reduction in function in one ear if you undergo surgery or gentamicin injections.  (Surgery or injection are sometimes used for those with more severe or frequent attacks, where the patient might feel that it is better to have some or all of their inner ear function permanently destroyed than to have it wildly fluctuating from the attacks.)  

Visit: www.lifemarkvestibular.ca today to find out more, and book an appointment with one of our vestibular rehabilitation therapists, who are available across the country.

For more information on Meniere’s disease, see this information from the Vestibular Disorders Association

http://vestibular.org/menieres-disease  or http://www.entnet.org/content/menieres-disease