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Ménière Disease

What Is It, Causes, Signs and Symptoms, and More

Author:Maria Emfietzoglou, MD

Editors:Alyssa Haag,Ian Mannarino, MD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy M. Johnson, LMSW


What is Ménière disease?

Ménière disease is a progressive condition that affects the inner ear, also called the labyrinth of the ear (i.e., the inner part of the ear that is divided into the vestibule, the semicircular canals, and the cochlea), which is responsible for balance and hearing. Ménière disease can lead to episodes of severe vertigo (i.e., spinning sensation), tinnitus (i.e., ringing in the ears), and hearing loss. As there is no cure, treatment focuses on managing symptoms and delaying the disease's progression. 

Cochlea of the inner ear.

What causes Ménière disease?

Although the cause of Ménière disease is currently unknown, several risk factors have been identified. These include genetic predisposition and family history; a viral infection or autoimmune response involving the inner ear; and atypical flow or drainage of endolymph (i.e., the fluid in the inner ear), which can be due to an obstruction or congenital malformation of the inner ear. In Ménière disease, regardless of the specific cause, there’s excessive fluid build-up in the lymphatic sac, also known as endolymphatic hydrops. As a result, increased pressure on the cochlea and the semicircular canals leads to progressive damage of the inner ear over time.

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What are the signs and symptoms of Ménière disease?

Signs and symptoms of Ménière disease can vary in intensity from being a mild annoyance to a disabling disease. Affected individuals typically present with a classic triad of symptoms, including severe vertigo, or feeling dizzy and off balance, tinnitus, and hearing loss, though not all of these symptoms may be present simultaneously. These symptoms typically present in episodes that begin abruptly and may last from several minutes to several hours. The intake of caffeine; alcohol; nicotine; high dietary salt; and monosodium glutamate (MSG), primarily found in protein-containing foods like meat, cheese, nuts, and legumes, can trigger episodes. Emotional stress, infections, or allergies are other potential triggers. Individuals with Ménière disease often also experience a feeling of ear fullness and pressure. Additional signs and symptoms can include headaches, nausea, and vomiting. Lastly, Ménière disease can interfere with the individual’s activities of daily living, such as working or driving.

As Ménière disease worsens progressively over time, it can result in permanent dysfunction, including irreversible hearing loss. Moreover, while most cases typically affect only one ear, as the disease progresses, it can extend to affect both ears

How is Ménière disease diagnosed?

Diagnosis of Ménière disease can be suspected based on medical history and physical assessment. Suspected individuals may be referred to an ear, nose, and throat (ENT) specialist. An audiometry exam, or hearing test, is usually done to assess hearing loss and other tests to evaluate balance function. Lab tests and imaging scans may also be ordered to rule out other disorders that can cause similar symptoms, such as migraines and ear infections. Ménière disease is thereby a diagnosis of exclusion.

How is Ménière disease treated?

As there’s no cure for Ménière disease, treatment focuses on reducing the number and severity of episodes and preventing disease progression. Initial treatment is typically focused on lifestyle changes to minimize exposure to triggers, such as limiting dietary salt intake, caffeine, alcohol, and nicotine and reducing emotional stress. In addition, individuals with Ménière disease can be referred to vestibular rehabilitation therapy, which consists of exercise activities to reduce vertigo and dizziness and improve balance function. Hearing aids can also be useful for individuals with permanent hearing loss

If symptoms persist despite lifestyle modifications, medications such as those that treat dizziness (e.g., antihistamines) can also be used. Patients can also be treated with oral or intratympanic glucocorticoids to reduce inflammation of affected ears or intratympanic gentamicin injection (usually the last resort treatment for severe disease) to destroy hair cells in the semicircular canals. Finally, individuals who do not respond to these options can be treated with surgery, such as endolymphatic sac decompression surgery to drain the excess endolymph. In the most severe cases with permanent hearing loss, a labyrinthectomy can be performed, in which the labyrinth is removed. 

What are the most essential facts to know about Ménière disease?

Ménière disease is a disorder of the inner ear that usually affects both hearing and balance. Although the exact cause is unknown, it is thought that endolymph build-up leads to increased pressure on the inner ear, causing progressive damage. The characteristic triad of symptoms includes vertigo, tinnitus, and hearing loss, typically in episodes lasting from minutes to several hours. Common triggers for the episodes include high salt intake, caffeine, alcohol, and emotional stress. Diagnosis is usually based on clinical presentation and physical examination but can also involve audiometry. As Ménière disease cannot be cured, treatment focuses on managing symptoms and delaying the disease progression. Treatment options can include lifestyle modifications, vestibular rehabilitation therapy, various medications (e.g., betahistine, diuretics, glucocorticoids), and surgery to drain excess endolymph or remove the labyrinth

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Related links

Meniere disease
Anatomy clinical correlates: Ear
Dizziness and vertigo: Clinical practice

Resources for research and reference

Healthline. Meniere’s disease: Symptoms, Causes, Treatment and More. Retrieved 18/07/2022 from https://www.healthline.com/health/menieres-disease

Healthy Hearing. Meniere’s disease. Retrieved 18/07/2022 from https://www.healthyhearing.com/help/tinnitus/menieres-disease

Mayo Clinic. Meniere’s disease. Retrieved 18/07/2022 from https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910

National Institute on Deafness and Other Communication Disorders. Ménière Disease. Retrieved 18/07/2022 from https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/MenieresDisease.pdf

National Health Service. Ménière Disease. Retrieved 18/07/2022 from https://www.nhs.uk/conditions/menieres-disease/

Osmosis. RN Nursing Science: Ménière Disease. Retrieved 18/07/2022 from https://docs.google.com/document/d/1f0PthG4w66RT_6rTD7y-mslqoUezg4eWP7NYNpHfIMk/edit