Menieres Disease

Diagnostic Criteria for Meniere’s Disease 

From: "International Classification of Vestibular Disorders" (Lopez-Escamez et al, 2015). 

Definite Meniere's disease:

  1. Two or more spontaneous episodes of vertigo lasting between  20 minutes and 12 hours
  2. Low to medium frequency sensorineural hearing loss. Thresholds must be at least 30 dB HL worse in the affected ear at two contiguous frequencies below 2000 Hz.
  3. Fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ears. Must occur within 24 hours of the vertigo episode.
  4. Not better accounted for by another vestibular diagnosis.

Probable Meniere's:

  1. Episodic vestibular symptoms (vertigo or dizziness) lasting 20 minutes to 24 hours associated with
  2. Fluctuating aural symptoms (hearing, tinnitus or fullness)
  3. Not better accounted for by another vestibular diagnosis

Ménière’s Disease: An Overview

This document is not intended to replace a consultation with an ENT specialist.

Ménière’s disease refers to a disorder affecting the inner ear which classically results in a triad of symptoms, namely, vertigo, tinnitus and hearing loss.

The classic presentation involves a sudden onset of symptoms that lasts from half an hour to many hours in duration. The patient may experience a cluster of such attacks over the space of a few days to weeks and then extended periods of calm before another cluster of attacks. The disorder may affect both ears in less than half of patients, and this generally occurs within five years after the onset. The process does tend to burn itself out after a number of years. It is important to differentiate this condition from other balance disorders, such as dizziness associated with fainting (syncope), or slurred speech as these may indicate a neurological or cardiovascular disorder.

The vertigo associated with Ménière’s disease is that of a sensation of rotatory movement and often results in the patient falling over. This is extremely debilitating and forces the person to lie down to prevent him/her injuring him/her-self. The patient is also extremely nauseous as a result of this. The patient will also experience a sudden worsening of their hearing in the affected ear during an attack, as well as a loud machinery-like buzzing sound in the ear. The hearing partially recovers between attacks, but there is usually a steady decline in hearing over time in the affected ear. In most cases, the person has some idea that an attack is imminent and can go and lie down before the world starts spinning. A small group of patients experience ‘drop attacks’ when they fall to the ground instantly, usually with painful consequences.

Other causes of balance disturbance are often confused with Ménière’s disease and need to be ruled out by an ENT specialist.

Ménière’s disease is thought to result from a loss of fluid and/or electrolyte homeostasis in the inner ear. Many different treatments have been proposed for treating this condition over the years. These range from low salt diets to medication to surgical procedures. Unfortunately, all long term treatment is directed at managing the vertigo – the hearing will progressively deteriorate regardless of the treatment.

The best non-surgical management involves maintaining as stable an electrolyte and fluid balance in the body as possible. Alcohol and caffeine may cause fluid shifts in the inner ear and may trigger attacks, and are best avoided. Medication (Serc©) may help some patients by preventing attacks. Surgical interventions vary, depending on the severity of the symptoms, the current level of hearing and whether one or both ears are involved. These range from the instillation of medication into the middle ear (which will diffuse into the inner ear) to destructive procedures which involve the selective cutting of the balance nerves or removal of the balance organs in the affected ear. There is much debate as to the effectiveness of surgical procedures to the endolymphatic sac. Recent studies have confirmed that devices which provide pulsed pressure to the ear are ineffective in managing this condition.

In most people with Ménière’s disease, the hearing deteriorates to a severe level in the affected ear. Such patients may still benefit from acoustic hearing aids. For those patients with profound hearing loss, or where a labyrinthectomy (removal of the balance organ) has been performed, a cochlear implant may restore the hearing. This may also be indicated when only one ear is affected.