Meniere's Disease

Dizziness is a common feeling, especially among headache sufferers. Some will experience true vertigo—the sensation that the room is spinning, or that they themselves are spinning. Although this very disturbing sensation can be caused by a number of illnesses, one possible diagnosis is Meniere’s disease.

Meniere’s disease typically begins with vertigo that builds over minutes, lasts hours, but can end abruptly. Attacks may occur in clusters and then disappear for months or years, recurring suddenly without provocation. Motion may make it worse; no position makes it go away. Vertigo may be associated with ringing in the ear (tinnitus), ear pain, and/or hearing loss, usually in one ear. Meniere’s may last 2 to 3 years, but can recur years later. Common associated symptoms include compromised or permanent hearing loss and imbalance.

Episodes of Meniere’s are caused by distortion and eventual damage to the balance and hearing center in the inner ear. Each bout of Meniere’s corresponds to an episode of damage. Repeated damage causes the brain’s balance center to become impaired. As the brain “resets” to the new set of signals, the vertigo ceases.

Treatment usually focuses on two initial strategies. The first step is relief of the acute symptoms of vertigo and nausea with such medications as meclizine (Antivert®) and metoclopramide (Reglan®). The second is to focus on decreasing excess endolymph pressure—the fluid in the inner ear. A low salt diet, avoidance of caffeine, and a diuretic such as  acetazolamide (Diamox®) are often recommended.

Surgical and pharmacological treatments may help, including in severe cases destruction of the inner ear itself. This stabilizes the input to the brain’s balance centers and eliminates the attacks, but often at the cost of further hearing loss. Therefore, such steps must be considered only after more conservative options have failed to provide relief of symptoms.

Meniere’s disease is not the only cause of vertigo. Therefore, a comprehensive history and physical by an experienced physician is needed to differentiate Meniere’s disease from other look-alike syndromes. An accurate diagnosis is the key to establishing the proper treatment for this aggravating but treatable disease.