Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon

Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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MENIERE’S DISEASE?

Meniere’s disease was first described in 1861 by a French physician called Prosper Meniere’s. It is thought that increased fluid pressure (endolymph) in the inner ear gives rises to the disorder which involves varying degrees of combinations of vertigo, tinnitus and hearing loss. Generally one ear is affected, although in around 10% of cases the second ear may show some changes also.

In an attack there may be sensation of spinning (vertigo) which can cause loss of balance. This may be accompanied by nausea, vomiting, sweating or even mild visual disturbances. The attacks can last from 1 or 2 minutes to several hours and may well be associated with a ringing noise in the ear (tinnitus). Sometimes there is a feeling of pressure in the affected ear just before or around the time of the attack. Between attacks it is possible for more minor appearances of various combinations of the symptoms The pattern of attacks varies between sufferers; some experience clusters of attacks followed by periods of remission, while others may have only one attack per year.

The incidence is thought to be around 1:50 000 and is a little more common in men than women. In certain cases hearing can be affected and sometimes there may be an associated loss of hearing; in one type the symptoms are predominantly of hearing rather than affecting the balance (Lemierre’s syndrome). In many cases, as the disease progresses, the hearing loss can become more pronounced but the attacks of vertigo, which are often the most troublesome component can reduce in severity and is also possible for the problem to go into spontaneous remission.

Referral to an ENT Surgeon is usually required to enable complete diagnosis and, if appropriate, to institute appropriate management. It is also likely that a hearing test involving a pure tone audiogram will be beneficial and sometimes imaging involving a scan can be necessary to exclude any other problems. Occasionally balance testing may be performed to test the inner ear balance function.

MANAGEMENT OF MENIERE’S DISEASE

There is no proven cure currently but various forms of treatment can be beneficial and at the least can produce long periods of freedom.


During an attack: Keep as still as possible while the vertigo lasts, preferably lying down in a quiet and darkened room. It can help to keep your eyes fixed on a stationary object. When the spinning sensation has ceased completely, move very cautiously and try to rest. It is common to feel exhausted after an attack.
Lifestyle: Stress should also be avoided, as it is thought to aggravate the symptoms of the disease.

Dietary factors: Reducing salt intake, to reduce any fluid retention, may be suggested in view of the possible association with increased inner ear fluid pressure. Avoidance of caffeine is also worth instituting and a trial of alcohol avoidance may be advised.

Medical treatment: Betahistine (Serc) is thought to act at the level of the inner ear (peripheral vestibular effect) and possibly also directly in the brain (central vestibular effect), to reduce the symptoms.

If an attack is particularly severe, then vestibular sedatives such as Prochlorperazine (Stemetil) may be needed to settle the dizziness. If nausea and vertigo are a problem a suppository can be a useful means of administering medication.

Hearing loss: A hearing aid may be beneficial after accurate ENT diagnosis to exclude any other associated problems.

Tinnitus: Tinnitus retraining therapy can be beneficial for this symptom; medications tend not to have a significant effect on this problem.

Vertigo: A trial of vestibular rehabilitation by balance exercises may be considered appropriate.

Surgery: Where attacks of vertigo persist for a considerable time, without responding to medication or other therapeutic treatments, the option of surgery may be considered. The decision will vary greatly from case to case and the ENT Specialist will be able to advise or even recommend further referral appropriately.

Insertion of a grommet in the eardrum may be attempted and sometimes can produce improvement in 50% of patients.

If this is not successful it is possible to proceed to an operation to decompress the endolymphatic sac. The aetiology of this operation is a little uncertain but up to two-thirds of patients may gain significant procedure from this procedure, although this entails a rather extended mastoid operation, and, as such does carry small risks to the hearing and the facial nerve.

A more precise, but quite technically demanding and invasive procedure, is to section of the vestibular nerve. This does carry a small risk of facial palsy, higher than that in the previous procedure and is likely to only be considered for intractable cases producing a very severe effect on lifestyle.


© Vincent Cumberworth 2005