Tinnitus, Vertigo, and Hearing Loss May equal Meniere’s Disease

Meniere’s Disease, named after French physician Prosper Meniere–who published his first article in 1861, is a disease of the inner ear that is characterized by episodes of vertigo, a sensation of fullness, tinnitus, and fluctuating hearing loss. Meniere’s Disease is linked to endolymphatic hydrops, or an excess of fluid in the inner ear. Diagnosis is most common in adults during in their 40’s and 50’s and appears to be slightly more prevalent in women. Usually, Meniere’s Disease only affects one ear, although can affect both.

It has been reported the Meniere’s Disease starts with one symptom and progresses, however not all symptoms need be present to obtain a diagnosis of Meniere’s. As mentioned above, there are several “typifying symptoms” which I will review individually:

Vertigo: Defined as the perception of movement, usually a spinning motion and come in “attacks”. Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Dizziness typically lasts 20 minutes to two hours. Some attacks can last 24 hours. In some with Meniere’s disease, their vertigo is so severe, that they lose their balance and fall in episodes called “drop attacks.”

Fullness: Defined as increased pressure or congestion in the ear.

Tinnitus: Defined as the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear. Many with Meniere’s Disease describe their tinnitus as a roar.

Hearing loss: Defined as a fluctuating loss, particularly early in the course of the disease. Eventually, most will experience some degree of low frequency permanent hearing loss.

Meniere’s Disease is most often diagnosed and treated by an otolaryngologist (AKA an ear, nose, and throat doctor, or ENT). As there is no definitive test or single symptom that a doctor can use to make the diagnosis, diagnosis is based upon your medical history. In 1995, the American Academy of Otolaryngology-Head and Neck Surgery established the following criteria for diagnosis:

Certain Meniere’s disease
Definite Meniere’s disease, plus histopathological confirmation

Definite Meniere’s disease
Two or more definitive spontaneous episodes of vertigo 20 minutes or longer
Audiometrically documented hearing loss on at least one occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded

Probable Meniere’s disease
One definitive episode of vertigo
Audiometrically documented hearing loss on at least one occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded

Possible Meniere’s disease
Episodic vertigo of the Meniere’s type without documented hearing loss, or
Sensorineural hearing loss, fluctuating or fixed, with disequilibrium but without definitive episodes
Other causes excluded

  1. Medications–The most disabling symptom is most often dizziness. Prescription drugs are usually prescribed.
  2. Salt restriction– Limiting salt helps some control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
  3. Other dietary and behavioral changes–Some claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
  4. Surgery–Surgery may be recommended when all other treatments have failed to relieve dizziness. One surgical option is decompression of the endolymphatic sac. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.

Due to the variable nature of the disorder, no single prognosis can be made for those suffering from Meniere’s Disease. While much is known about the symptoms and treatments associated with Meniere’s Disease; the underlying cause is not well understood. More research is necessary to obtain a better understanding of the disease process, which will likely increase treatment efficacy.

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