Menieres Disease
What is it?
Meniere’s disease is a chronic disorder of your inner ear (vestibular system) that produces recurring attacks of vertigo, balance and progressive hearing issues/loss. It is quite a rare condition and affects around 1% of the general population. Symptoms normally last between 20 minutes to 12 hours. It often only affects one ear and most common in adults between 40-60 years old.
Symptoms often include:
- Vertigo/Dizziness, lightheadness
- Hearing Loss: Can get progressively worse with each attack
- Tinnitus: ringing or buzzing sound in the ear
- Sense of ear fullness and/or headaches
- Sound sensitivity
Vestibular System Recap
Your vestibular system (inner ear) is compromised of the vestibular organ in the inner ear (the sensor), your brain (the processor) and the vestibular nerve which links the inner ear to the brain.
The inner ear sensor is embedded in your skull, and you have one on either side. They act as GPS units that picks up on head/body position and sends information to your brain. Your brain then processes this information and sends out messages to your eye, trunk, arm and leg muscles to help you maintain balance.
There are three canals as part of the inner ear sensory system. These canals are hollow and filled with fluid (called endolymph) that moves as your head moves. There are little hair receptors in the canal (think of seaweed floating in water), so when you turn/move your head, the fluid moves which deflect the hair receptor that sends information to the brain which processes the information to determine if the direction and speed of your head movement.
What causes it?
Source: T Nakashima et al, 2016, Meniere’s disease. DOI: https://doi.org/10.1038/nrdp.2016.28
The exact cause of Meniere’s disease is not fully understood. The leading theory is that it is a result of a buildup of fluid (endolymph) in the inner ear which causes increased pressure. The increased pressure in the canal will then continuously compress/deflect the hair receptors in the canal which constantly incorrect messages to the brain causing a vertigo attack. It is uncertain which causes/triggers the build-up of fluid.
Your inner ear system also includes the cochlear (hearing component). In Menieres, there is also abnormal fluid build-up in the cochlear which explains why hearing is also widely impaired. People often feel fullness in the ear, tinnitus and or a “swooshing” sensation prior to an attack.
These attacks can last between 20 minutes to 12 hours. Following an attack, a period of extreme fatigue/exhaustion occurs prompting the need for increased sleep. Periods between attacks and can be separated by weeks, months and even years. Some people are symptom free for some whilst symptomatic for others. The unpredictable nature of this disease makes management very challenging.
Some people with Menieres find certain factors can trigger attack including:
- Stress
- Fatigue/overwork
- Anxiety
- Certain foods
- High sodium diet
Progression of Disease
Symptoms vary in the early and latter stages of Menieres Disease. Over time, the abnormal fluid build-up causes irreparable damage to the balance and hearing sensors. Menieres often start with either fluctuating hearing loss and tinnitus and eventually progresses to combination of hearing impairments as well as attack of vertigo and dizziness. Unfortunately, there is no cure for Menieres disease However, many people can manage their symptoms through medications, lifestyle changes, vestibular rehabilitation and in very rare cases surgery.
Diagnosis
There is a select criterion when diagnosing Menieres Disease. Often other vestibular conditions such as vestibular migraine and BPPV needs to be ruled out, as it can mimic symptoms of Menieres.
The diagnostic criteria for Menieres disease by the Barany Society involves
- 2 or more spontaneous episodes of vertigo each lasting 20 minutes to 12 hours
- Low to medium frequency hearing loss on audiometry testing of the affected ear
- Fluctuating symptoms of tinnitus, hearing loss and feeling of pressure/fullness in the affected ear
Treatment
There is currently no cure for Menieres Disease. However, there are treatments to help reduce your symptoms during, after and between attacks. These could include specific medications (often diuretics) and vestibular rehabilitation. There are also lifestyle modifications (i.e more exercise, low sodium diet) that can reduce the risk of an attack recurring.
Vestibular Rehabilitation
Often Menieres patients who have residual symptoms find vestibular rehabilitation extremely helpful after/between attacks. Many patients report symptoms including:
- Fatigue
- Headache/brain fog
- Lightheadedness
- Unsteadiness/ balance issues particularly with head turns, turning, at night/dark areas.
- Motion sensitivity
- Nausea
Often, due to these patients start to avoid these activities. This often includes:
- Slow walking speed
- Avoid turning their head, instead whole trunk
- Avoiding leisure/sports (golf, pilates, yoga, walking)
- Avoid leaving the house
These behaviours can be very detrimental in the long term. Balance is a skill and the ability of the brain to process sensory information is a skill. If you do not USE IT you will LOSE IT. If you continue to avoid activities weeks after a Menieres attack you are no longer challenging your balance and brain processing skill and overtime these skills will decrease quickly and your symptoms will worsen over time, so the next time a Menieres attack happens symptoms during and after are often worse.
Our vestibular physiotherapists will perform a thorough initial assessment which includes oculomotor, balance and vestibular system specific tests to determine the impairments/deficits that need to be addressed after a Menieres attack. An individualised vestibular rehabilitation program will be prescribed which often include gaze stability, static and dynamic balance and motion habituation exercises to help you get your life back on track.
John Ma
Vestibular Physiotherapist