CHILDREN'S HEALTH Ear/Nose/Throat • Earwax blockage • Acute sinusitis • Hearing loss • Chronic sinusitis • Tonsillitis • Ear infection, middle ear • Tinnitus • Laryngitis • Airplane ear • Swimmer's ear • Nasal polyps • Ruptured eardrum • Sore throat • Epiglottitis • Benign paroxysmal positional vertigo (BPPV) • Meniere's disease • Nonallergic rhinitis

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Meniere's disease is a condition characterized by sudden, sometimes severe attacks of vertigo, which is the sudden and unsteady sensation that you or your surroundings are moving or spinning.

Named after 19th-century French physician Prosper Meniere, Meniere's disease involves an increase of fluid pressure in your inner ear, disrupting your balance and hearing.

Although the attacks associated with Meniere's disease can be disturbing and sometimes disabling, Meniere's disease itself isn't life-threatening. Treatment options and self-care tactics for Meniere's disease can help you manage the effects of the condition.

The periodic attacks that occur in Meniere's disease last 20 minutes to an hour or longer. Signs and symptoms usually are severe and may include:

• Sudden, severe episodes of vertigo, often accompanied by nausea and vomiting
• Hearing loss in the affected ear
• Buzzing, ringing or roaring sound in the affected ear (tinnitus)
• Feeling of fullness, pressure or pain in the affected ear

Attacks can happen without warning and may become increasingly frequent and severe. Generally no signs and symptoms occur between attacks.

Meniere's disease generally occurs in only one ear. In rare cases, both ears can be affected. As the disease progresses, hearing loss may be more pronounced and less likely to fluctuate with attacks, and tinnitus and ear fullness may be stronger and more constant. The vertigo attacks may subside over time.

For most people, the attacks are infrequent and the disorder is primarily an inconvenience. But for some people, Meniere's disease can lead to complete deafness in the affected ear, and the vertigo and accompanying nausea can be frequent and debilitating. However, most people with the disease are able to maintain their normal daily activities with proper treatment and self-care strategies.

The organ of balance in your inner ear is the vestibular labyrinth. It includes loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that control your sense of balance. It consists of part bone (bony labyrinth) and part membranes (membranous labyrinth).

The membranes of the vestibular labyrinth, which are necessary for hearing and balance, are surrounded by bone and filled with fluid (endolymph). When you move your head, the fluid moves, causing nerve receptors in the membranes to send signals to your brain about your body's motion.

In Meniere's disease, an increase in this fluid can produce abnormal signals that tell your brain you're in motion even though you're actually stationary. Excess endolymph can also cause the membranes of the vestibular labyrinth to rupture.

The cause of Meniere's disease is unknown. A rupture in the membranes of the labyrinth may cause endolymph to mix with perilymph, another inner ear fluid. This mixing of fluids may cause the signs and symptoms characteristic of Meniere's disease.

See your doctor if you experience any unexplained, recurrent or severe vertigo. Although it's uncommon for vertigo to signal a serious illness, see your doctor immediately if you experience dizziness along with any of the following:

• A new, different or severe headache
• Double vision or loss of vision
• Hearing loss
• Speech impairment
• Leg or arm weakness
• Loss of consciousness
• Falling or difficulty walking
• Numbness or tingling
• Chest pain
• Rapid or slow heart rate

These signs and symptoms may signal a more serious problem, such as stroke, brain tumor, Parkinson's disease, multiple sclerosis, or diseases of your heart or blood vessels (cardiovascular disease).

To determine if you have Meniere's disease, your doctor will likely begin by asking you a number of questions about your dizziness. In trying to determine the cause, your doctor may ask if your dizziness:

• Causes the room to spin or a sensation of motion (vertigo)
• Is associated with a feeling of faintness or lightheadedness
• Causes you to lose your balance
• Is accompanied by ringing or fullness in your ears or trouble hearing

Your doctor will ask you when you experience dizziness, how long it lasts and how often it occurs. He or she will likely review your medical history and current medications, conduct a physical examination, and order further testing based on your signs and symptoms. In addition, you may need a consultation with an ear, nose and throat (ENT) specialist or a doctor who specializes in the nervous system (neurologist) to confirm a diagnosis of Meniere's disease.

The American Academy of Otolaryngology — Head and Neck Surgery (AAO-HNS) has proposed diagnosis criteria for Meniere's disease. According to AAO-HNS guidelines, a definite diagnosis of Meniere's disease requires:

• Two spontaneous episodes of vertigo each lasting 20 minutes or longer
• Ringing in the ear (tinnitus) or feeling of fullness in the ear
• Documented hearing loss on a hearing test

Tests to aid in diagnosing
Although there's no specific test for Meniere's disease, doctors use certain tests in combination to help diagnose the disorder. These include:

• Hearing test (audiometry). A hearing test determines if you have hearing loss associated with Meniere's disease. By using several types of hearing tests, your doctor can tell if hearing loss is specific to your inner ear.
• Electronystagmography (ENG). This test evaluates balance (vestibular) function by detecting abnormal rhythmic eye movement (nystagmus) often present with Meniere's disease. ENG can help to identify inner ear disease by measuring involuntary eye movement while your balance is stressed in different ways. In about half the people with Meniere's disease, balance function is reduced in the affected ear.
• Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these detailed, clear images to identify and diagnose a wide range of conditions. MRI may be performed to rule out central nervous system disorders that can mimic Meniere's disease, such as acoustic neuroma (a noncancerous brain tumor of the acoustic nerve, which carries sound from the inner ear to the brain), Arnold-Chiari malformation and multiple sclerosis.

Complications of Meniere's disease may include:

• Increased risk of falling
• Increased risk of an accident while driving a car or operating heavy machinery
• Permanent partial or total hearing loss in the affected ear
• Increased risk of depression or anxiety in dealing with the disease

The goal of treatment for Meniere's disease is to manage your signs and symptoms and prevent or decrease the number of attacks. Prescription drugs and other therapies may help:

Medications
You may be able to control or relieve specific signs and symptoms of Meniere's disease with certain medications:

• Vertigo. Anti-vertigo medications, such as meclizine (Antivert), may combat the spinning sensation.
• Nausea and vomiting. Drugs such as prochlorperazine (Compazine) can control nausea and vomiting.
• Anxiety. Anti-anxiety medications, such as alprazolam (Xanax), may help relieve anxiety that can accompany a serious attack.

Your doctor also may prescribe a medication to reduce fluid retention (diuretic), such as the drug combination triamterene and hydrochlorothiazide (Dyazide, Maxzide). Reducing the amount of fluid your body retains may help regulate the fluid pressure in your inner ear.

Because diuretic medications cause you to urinate more frequently, your system may become depleted of certain minerals, such as potassium. If you take a diuretic, supplement your diet each week with three or four extra servings of potassium-rich foods, such as bananas.

Dietary changes
Modifying your diet can reduce your body's fluid retention and help decrease fluid buildup in your inner ear. Your doctor may suggest you follow these dietary changes to lessen the effects of Meniere's disease:

• Eat regularly. Distributing evenly what you eat and drink throughout the day helps regulate your body fluids. Eat approximately the same amount of food at each meal. If you snack, do so regularly.
• Limit salt. Consuming foods and beverages high in salt can cause fluctuations in fluid pressure in your inner ear. Aim for an intake of 1,000 milligrams (mg) or less of sodium each day.
• Watch for monosodium glutamate (MSG). Prepackaged food products and Chinese food include MSG, which contains sodium. MSG can contribute to fluid retention and worsen your symptoms.
• Avoid caffeine. Foods and beverages that contain caffeine, such as chocolate, coffee, tea and certain soft drinks, have stimulant properties that can make your symptoms worse. For instance, caffeine may make ringing in the ear (tinnitus) louder.
• Stop smoking. Avoiding nicotine often lessens the severity of Meniere's disease symptoms.

Middle ear injections
In this approach, your doctor injects gentamicin (Garamycin), an antibiotic that's toxic to your inner ear, through your eardrum and into your inner ear, where it's absorbed. This reduces the balancing function of your ear, and your other ear assumes responsibility for balance. The procedure, which can be performed with local anesthesia in your doctor's office, often reduces the frequency and severity of vertigo attacks.

Injections with a steroid called dexamethasone also may help control vertigo attacks in some people. Although dexamethasone injections may be slightly less effective than gentamicin, dexamethasone is less likely than gentamicin to cause further hearing loss.

Surgery
If the vertigo attacks associated with Meniere's disease are severe and debilitating and medical treatments don't help, surgery may be an option. Procedures may include:

• Endolymphatic sac procedures. These surgical procedures reduce the swelling caused by endolymph buildup. In endolymphatic sac decompression, some of the bone surrounding your inner ear is removed. In some cases, endolymphatic sac decompression is coupled with the placement of an endolymphatic shunt, a tube that drains excess fluid from your inner ear. Another surgical approach called a sacculotomy involves implanting a permanent, tack-like device that allows endolymph to drain out of your inner ear whenever pressure builds up.
• Labyrinthectomy. This procedure removes your entire inner ear sense organ (vestibular labyrinth). The operation may be an option if antibiotic injections don't help and you have near-total or total hearing loss in your affected ear.
• Vestibular neurectomy. This procedure involves cutting the nerve that controls your balance (vestibular nerve). When hearing loss is severe or Meniere's disease involves intense vertigo, a vestibular neurectomy may be done to surgically destroy your entire inner ear. Your other ear then takes over the balance function.

Rehabilitation
If you experience problems with your balance between attacks, you may benefit from vestibular rehabilitation therapy. The goal of this therapy, which may include exercises and activities that you perform during therapy sessions and at home, is to help your body and brain regain the ability to process balance information correctly.

Certain self-care tactics can help reduce the frequency and severity of the attacks associated with Meniere's disease. Consider these tips:

• Learn about your condition. Know how to recognize the warning signs of an attack of Meniere's disease.
• Sit or lie down immediately when you feel dizzy. During an attack, avoid things that can make your signs and symptoms worse, such as sudden movement, bright lights, watching television or reading.
• Rest during and after attacks. Don't rush to return to your normal activities.
• Be aware of the possibility of losing your balance. Falling could lead to serious injury. Use good lighting if you get up in the night. Consider walking with a cane for stability.
• Avoid driving a car or operating heavy machinery if you experience frequent episodes of vertigo. Doing so could lead to an accident and injury.
• Consider a hearing aid. This may be necessary if you experience hearing loss.
• Avoid using caffeine, alcohol and nicotine. Excessive use of these substances can constrict your blood vessels and worsen your symptoms.
• Work closely with your doctor. This may help you manage your symptoms effectively.

Meniere's disease may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find encouragement and understanding in a support group.

Although support groups aren't for everyone, they can be good sources of information. Group members often know about unique coping skills and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area.