Ménière’s Disease: Symptoms, Causes and Treatments

What causes Ménière’s disease?

Doctors don’t know for sure what causes Ménière’s disease. But it’s generally believed that it’s related to a problem with fluid in the inner ears.

“We think it’s either production of too much fluid or not enough absorption, but for whatever reason, this pressure in the inner ear exists and it causes episodic bouts of vertigo, hearing loss and ringing in the ears,” Hildrew says.

What’s behind this fluid malfunction could be an abnormal inner ear shape, an autoimmune disorder, a viral infection or perhaps genetics.

But while genetics may drive your risk for developing Ménière’s disease, it doesn’t seem to be caused by direct inheritance from your parents. “By far, the vast majority of patients are not telling me ‘My dad has it. My brother has it.’ They’re just isolated incidents,” Hildrew says.

How is Ménière’s disease diagnosed?

There is no single definitive test for Ménière’s disease diagnosis. But if, by chance, you can see your doctor during an episode, there are tests they can do that can provide evidence of Ménière’s disease’s effects on your inner ear. But Hildrew reiterates it’s rare to actually catch a patient in an episode when they’re actively dizzy.

Outside of an active episode, doctors look for patients to report that telltale combination of symptoms that involve both hearing and balance issues, including:

• Hearing loss in one ear that fluctuates
• Fullness or pressure in the ear
• Tinnitus or another phantom sound in the ear
• Spells of vertigo

Your doctor may order a complete hearing test with an audiologist to confirm that the pattern of hearing loss aligns with Ménière’s disease as opposed to something else that might be causing it, like age.  

“It’s low- to mid-frequency hearing loss, which is the inverse of so-called age-related hearing loss,” Crowson says.

Your doctor might also want to order tests to rule out other causes of your symptoms. You may have tests that check the balance system in your inner ear and the reflexes of your eye muscles. Your doctor may also order an MRI to rule out other medical problems, such as neurological conditions or tumors, as the cause of your symptoms.  

Without a clear-cut test for Ménière’s disease, it’s common for doctors to tell patients they have the condition when they don’t. “It’s by far the most over-diagnosed cause of dizziness,” Hildrew says.

What is Ménière’s disease treatment?

While there’s no cure for Ménière’s disease, lifestyle changes and treatments can help make your symptoms less frequent and less severe.

Diet and lifestyle changes

Your doctor might recommend that you:

• Cut back on caffeine and alcohol
• Manage your stress
• Switch to a low-sodium diet that includes no more than 1,500 mg of salt per day

Medications

Your doctor might prescribe medications, such as:

• Water pills (diuretics), which reduce the amount of fluid in your body by making you go to the bathroom a lot
• Betahistine (Serc), which can ease fluid pressure in the ear by improving circulation in the area
• Motion sickness and anti-nausea medications to reduce vertigo or ease the nausea that can come with it
• Steroids, called prednisone, to take during an active attack

Injections

If pills don’t help, you might benefit from injected medications, such as:

• Steroids, injected into the ear drum, to cut down on the number of episodes you have
• An antibiotic, called gentamicin (Garamycin), that damages the part of the ear causing vertigo so that it can’t continue to affect you, but it comes with the risk of more hearing loss.

Physical therapy

In addition to medication, you might benefit from vestibular rehabilitation, which involves exercises to improve your balance and manage your vertigo symptoms.

Surgery

Your doctor may recommend surgery as a last resort if other treatments don’t help. One procedure drains the fluid buildup in the endolymphatic sac. Another, which is used less often, cuts the vestibular nerve in the ear that’s causing your vertigo. 

Experts recommend people with Ménière’s disease who have hearing loss not wait until it gets severe to get hearing aids. Hearing loss is easier to treat with hearing aidswhen it’s mild to moderate.

What does the future hold?

Researchers are testing cutting-edge treatments and procedures that could one day help restore the vestibular system after it’s destroyed by Ménière’s.

Hair cell regeneration aims to regrow the tiny, damaged hairs in the ear that are imperative to balance. “Initially, that targeted hearing restoration,” Crowson says, “but we have discovered over time that the tissue of the balance system is very similar to the hearing system, so we’re thinking we could maybe apply those techniques to regenerate the balance system.”

Other research is exploring the possibility of something like a cochlear implant for the vestibular system. Rather than restore hearing, it would restore balance. “Similar technology, but instead of stimulating the hearing system, electrodes would stimulate the balance system,” Crowson says. “These are in human trials.”