Ménière's disease

A disorder of the inner ear

What is Ménière's disease?

A disorder of the inner ear, Ménière's disease is a progressive condition that can develop at any age. It affects balance and hearing, causing vertigo, dizziness and hearing loss. In most cases, people with Ménière's disease experience symptoms in one ear and often experience a gradual decline in hearing in the same ear.

Ménière's disease is characterised by bouts of vertigo, which can be very severe and last for anywhere from two to four hours at a time. While attacks will usually subside after a few hours, it may take several days for the symptoms to disappear completely. For some, vertigo attacks can be very frequent, with several occurring in a short time, while for others, months and even years may go by between episodes. These attacks can come on suddenly or may be preceded by warning signs such as earache, a ringing, roaring or hissing sound in the ear (tinnitus), abnormal hearing or a feeling of pressure in the ear.

Who is affected?

Ménière's disease is not a common condition; however, it can develop at any age and affects both genders equally. The condition tends to fluctuate, with phases of acute symptoms followed by phases of remission. Certain sufferers may experience further complications, for example, those with professions that rely on a sense of balance, such as scaffolders, pilots, and bus drivers.

How common is Ménière's disease?

Ménière's disease is not a very common condition, estimated to affect up to 750 people per 100,000. While it can affect people of any age, Ménière's disease most commonly affects people in their 40s and 50s and is rarely seen in children.

Causes of Ménière's disease

At present, the cause of Ménière's disease is unknown. However, the symptoms of the condition are caused by a build-up of fluid within the inner ear. This fluid is called endolymph, and it plays a key role in the body’s movement, balance and position, stimulating receptors that send signals to the brain about these bodily functions.

The endolymphatic sac, which is part of the inner ear, is supposed to reabsorb this fluid. It is believed that when this fails to happen, too much endolymph accumulates in the ear, swelling the surrounding membranes, preventing the ear from functioning properly and triggering vertigo. However, this hypothesis is yet to be confirmed.

There are certain risk factors associated with Ménière's disease, and a person may be at higher risk of developing the condition if they:

  • Have a family member with Ménière's disease
  • Have an autoimmune disease such as diabetes, lupus or rheumatoid arthritis
  • Have allergies
  • Have had prior head injuries, particularly those involving the ear
  • Have had previous viral infections of the inner ear
  • Experience poor fluid drainage
  • Have a chemical imbalance in the endolymph
  • Have a health problem affecting the blood vessels

Symptoms of Ménière's disease

Ménière's disease symptoms are often experienced in attacks that start suddenly and last for several hours at a time. People with the condition may experience attacks frequently or more sporadically, with days, weeks or months between each attack.

Some common Ménière's disease symptoms include vertigo, noise sensitivity, trouble hearing clearly, tinnitus, pressure within the ear and hearing loss.

The condition's progression is identified by three stages: early, middle and late stages. Early stage Ménière's disease is characterised by sudden, unpredictable attacks, while later stages see the frequency of attacks lessen over time. However, the way that Ménière's disease progresses varies from person to person.


What are the three stages of Ménière's disease?

It’s important to note that as Ménière's disease progresses, the degree of hearing loss experienced often increases. Tinnitus also commonly accompanies increased hearing loss.

Ménière's disease can be divided into three stages: early, intermediate and late. Symptoms may vary between people and over time.  What are the three stages of Ménière's disease? Let’s take a closer look. 

Early Stage

The earliest stage of Ménière's disease includes unpredictable vertigo attacks, which can last from a few minutes to hours. During the attack, there may be a variable amount of hearing loss and a feeling of fullness in the ear. Some people may also experience tinnitus in the affected ear during this stage of the disease, which may precede a bout of vertigo. However, the attacks can often come without warning. Vertigo may also cause nausea, vomiting and dizziness.

Middle Stage

Vertigo attacks continue in the intermediate stage; however, they may now be less severe. A period of movement-induced dizziness or loss of balance may occur before or after the attack, and there may be symptoms of tinnitus along with the development of hearing loss and continued vertigo.

Late Stage

In late-stage Ménière's disease, hearing loss symptoms increase, and the symptoms of vertigo often reduce or stop completely. Hearing loss may be severe at this stage, and distortion and discomfort with loud sounds may occur. At stage 3 of the condition, balance problems are common (particularly in the dark) due to the permanent damage to the balance organ in the ear.

How do you test for Ménière's disease?

There is no specific test for Ménière's disease, but if you are experiencing vertigo with hearing loss, tinnitus and a feeling of fullness or pressure in the ear, an ear, nose and throat specialist may use a range of tests to confirm a diagnosis of this disorder. The ENT will likely perform hearing tests to check if hearing loss is specific to the inner ear.

Low-frequency hearing loss is often an indicator of Ménière's disease. They may also perform an electronystagmography to measure involuntary eye movement while your balance is tested and may recommend an MRI to rule out central nervous system disorders that have similar symptoms to Ménière's disease.


Ménière's disease treatment

If you are experiencing vertigo, book an appointment with your GP. Depending on their assessment of your symptoms, you may be referred to an ear, nose and throat specialist or prescribed medication to help alleviate the severity of your symptoms.

People who receive this diagnosis often ask, how long does Meniere's disease last? Ménière's disease is an ongoing condition that unfortunately can’t be cured. However, some people with the condition experience periods of remission where the symptoms are mild or non-existent.

Here’s what you can do to manage the condition:


During an attack

Becoming acquainted with the typical warning signs of an attack and common triggers can help you prepare for and better handle a vertigo episode. If you do notice one coming on:

  • If you have medication, take it as soon as you can (more on this shortly)
  • Sit or lie down or grab your nearest available support
  • Try not to move, but if you have to, do it slowly
  • Close your eyes or focus on an object that is not moving
  • Don’t make any sudden movements with your head

After an attack, be sure to prioritise rest and give your brain time to recover and readjust before you go back to your usual activities.


Diet & lifestyle changes

As there is no cure, Ménière's disease treatment focuses on managing symptoms and preventing (or reducing the severity of) attacks. This can be done partially by implementing lifestyle changes like those listed below:

  • Avoid alcohol, caffeine and smoking, as all three substances can trigger vertigo episodes. Research suggests that both alcohol and coffee can restrict blood flow to the inner ear, which can make Ménière's disease symptoms worse.
  • Reduce your daily sodium intake. Though more research is needed, a diet low in salt is believed to help minimise the fluid pressure in your inner ear and, consequently, the symptoms of Ménière's disease.


There are medications you can take to control nausea, vertigo and fluid retention within the ear, including:

  • Meclizine, which is a motion sickness drug
  • Promethazine, which is an anti-nausea medication
  • Diuretics, which help reduce fluid retention

In some cases, doctors may also suggest middle ear injections. These injections may be of gentamicin, an antibiotic that helps with vertigo but may cause hearing loss, or steroids, which don’t cause hearing loss.

Vestibular rehabilitation therapy

Vestibular rehabilitation therapy helps you manage dizziness and unsteadiness through exercises completed with a physical therapist or at home. Although it isn’t an instant solution to vertigo, it offers many benefits, like improving your balance in the long run, increasing body strength and reducing your risk of falling.

Hearing aids for Ménière's disease

If you are experiencing hearing loss as a result of Ménière's disease, hearing aids (many of which are designed to also alleviate tinnitus) can be an option.


In some severe cases, surgery may be required to reduce the amount of fluid within the inner ear or to cut the nerve that sends balance and movement signals to the brain. Although surgery will not cure the condition, it may help to reduce the severity of symptoms such as vertigo.

If your vertigo doesn’t respond to medical intervention, your doctor may also suggest pressure pulse devices, which can help relieve pressure build-up within the ear and thus reduce vertigo. Chemical ablation is another non-surgical option for treatment-resistant vertigo. In this procedure, doctors use an antibiotic to reduce or destroy the ear’s vestibular functions (responsible for balance). In doing so, signals are no longer sent to the brain.

If attacks are triggered by stress, it is worth speaking to your healthcare practitioner about mental health support.

Ménière's disease can be difficult to live with, especially if you are experiencing its early stages. Consider connecting with a support group if you have questions about living with symptoms, dealing with attacks or monitoring the condition’s progression.


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