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Meniere's Disease (Endolymphic Hydrops)


Disease: Meniere's Disease (Endolymphic Hydrops) Meniere's Disease (Endolymphic Hydrops)
Category: Ear, nose, larynx diseases

Disease Definition:

A disorder of the inner ear that causes abnormal sensory perceptions including hearing loss usually in one ear, a sensation of a spinning motion (vertigo), ringing in the same ear (tinnitus) and fullness or pressure in the same ear, is called Meniere's disease.


Meniere's disease is more likely to develop in people in their 40s and 50s than people in other age groups.

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Symptoms, Causes


The primary signs and symptoms of Meniere's disease are:

Hearing loss: 

Early in the course of the Meniere's disease in particular, hearing loss may fluctuate. Some degree of permanent hearing loss is eventually experienced by most people with this disease.

Aural fullness:

The feeling of fullness or pressure in the ear is what is meant by aural fullness.

Recurring episodes of vertigo:

Vertigo is similar to the sensation one experiences if he/she spins around quickly several times and suddenly stops. The person feels as if the room is still spinning, and he/she loses balance. Nausea and vomiting may result from severe vertigo. The episodes of vertigo usually last from 20 minutes to two hours or more, and they occur without warning.


The perception of whistling, buzzing, roaring, ringing or hissing sound in one's ear is called tinnitus.


The duration, frequency and severity of each of these sensory perception problems vary. For instance, one may experience mild vertigo and hearing loss infrequently but have frequent tinnitus that disturbs his/her sleep. Or one could have frequent episodes with severe vertigo and only mild disturbances in other sensations.


What causes Meniere's disease is not well understood. The abnormal composition of fluid in the inner ear or its abnormal volume appears to be the cause. However, it's still not known what factors actually cause these changes in the inner ear fluid.


A cluster of connected passages and cavities called a labyrinth make up the inner ear. The outside of the inner ear is made of bone (bony labyrinth). A soft structure of membrane (membranous labyrinth) which is a slightly smaller, similarly shaped version of the bony labyrinth is found on the inside.


The membranous labyrinth contains a fluid (endolymph) and is lined with hair-like sensors that respond to movement of the fluid. Nerve impulses that are sent to the brain are created by these sensors. Each part of the inner ear is responsible for a different type of sensory perception as the following:


  • A person detects his/her own acceleration movement in any direction with the help of the sensors in a portion of the membrane in the center section of the labyrinth called vestibule.
  • Branching off from one side of the vestibule are three loops called semicircular canals. Sensors in the semicircular canals are important for maintaining one's balance and they enable him/her to sense his/her own rotational motion.
  • A snail shaped structure called cochlea, which is the hearing part of the inner ear, is on the other side of the vestibule. Waves in the inner ear fluid, which the sensors in the cochlea translate into impulses sent to the brain, are created by the vibrating bones of the middle ear.


The fluid needs to retain a certain chemical composition, pressure and volume in order for all of the sensors in the inner ear to function properly. Menieres's disease can be contributed to by factors that alter the properties of the inner ear fluid.
Both ears can be affected by Meniere's disease in some rare cases, as it generally occurs in only one ear.



The most debilitating problem of Meniere's disease is usually the unpredictable episodes of vertigo. A person is often forced to lie down for several hours and lose time from work or leisure activities because of the episodes which can cause embarrassment.


The risk of the following can be increased by vertigo:


  • Accidents while operating heavy machinery or driving a car
  • Depression or anxiety in dealing with the disease
  • Falls


Some symptoms may be managed through a number of strategies as there's no cure for Meneire's disease. The strategies are:



To lessen the severity of an attack of vertigo, medication may be prescribed to be taken during an episode:

Anti-nausea medications:

During an episode of vertigo, medications like prochlorperazine may control nausea and vomiting.

Motion sickness medications:

The nausea and vomiting can be controlled and the spinning sensation of vertigo can be reduced by meclizine or diazepam.



A person may be prescribed combination triamterene and hydrochlorothiazide, which are medications that reduce fluid retention (diuretics). The fluid pressure and volume in the inner ear may be regulated by reducing the amount of fluid one's body retains. A diuretic helps control the frequency and severity of the symptoms of Meniere's disease for some people.


The patient's system may become depleted of certain minerals such as the potassium, because diuretic medications cause him/her to urinate more frequently. Because of this, the patient should supplement the diet each week with three or four extra servings of potassium-rich foods like spinach, cantaloupe, bananas, sweet potatoes and oranges.



Surgery may be an option if vertigo attacks associated with Meniere's disease are severe and debilitating and other treatments don't help. The procedures may include:


The surgeon removes a portion or all of the inner ear in this procedure, thereby removing both balance and hearing function from the affected ear. This procedure is only performed if the patient has total or near-total hearing loss in the affected ear.

Vestibular nerve section:

Cutting the nerve that connects balance and movement sensors in the inner ear to the brain (vestibular nerve) is involved in this procedure. While attempting to preserve hearing in the affected ear, this procedure usually corrects problems with vertigo.

Endolymphatic sac procedures:

The endolymphatic sac plays a role in regulating inner ear fluid levels. By increasing fluid absorption or decreasing fluid production, these surgical procedures may alleviate vertigo.
A small portion of bone is removed from over the endolymphatic sac in endolymphatic sac decompression. This procedure is coupled with the placement of a shunt, which is a tube that drains excess fluid from the inner ear In some cases.



The body's fluid retention can be reduced and the fluid in the inner ear can be decreased by modifying the diet. To lessen the severity and frequency of the symptoms of Meneire's disease, these dietary changes are suggested to be followed:

Avoiding monosodium glutamate (MSG):

Some Asian foods and prepackaged food products include MSG, a type of sodium. Fluid retention can be contributed to by MSG.

Eating regularly:

Body fluids can be helped to be regulated by distributing evenly what one eats and drinks throughout the day. At each meal, it's better to eat approximately the same amount of food. One may even eat five or six smaller meals rather than three meals a day.

Limiting salt:

Fluid retention can be increased by consuming foods and beverages high in salt. This means that a person should aim for an intake of 1,000 to 1,500 milligrams (mg) or less of sodium each day.



The patient may benefit from vestibular rehabilitation therapy if he/she experiences problems with the balance between episodes of vertigo. To help the patient's body and brain regain the ability to process balance information correctly is the goal of this therapy, which may include activities and exercises that the patient performs during therapy sessions and at home.



Lifestyle factors are suggested by some evidence to worsen symptoms of Meniere's disease or act as triggers for the onset of symptoms. To alleviate symptoms or help prevent the onset of symptoms, the following changes may be recommended:

Avoiding caffeine:

Beverages and foods that contain caffeine like coffee, chocolate and certain soft drinks, have stimulant properties that can make symptoms worse. For example, caffeine may make ringing in the ear (tinnitus) louder.

Quitting smoking:

The severity of the symptoms of Meniere's disease may be lessened by avoiding nicotine.

Managing stress and anxiety:

Whether stress and anxiety are the result of having Meniere's disease or they act as triggers for the disorder is difficult to know. Anyways, some evidence suggests that managing stress and anxiety may lessen the severity of symptoms and enable the patient to cope with the disorder. To help the patient identify stressors and develop strategies for dealing with stress and anxiety, professional psychotherapy may be good. The patient may also use medications to alleviate anxiety.



Vertigo symptoms may be improved by medications injected into the middle ear and then absorbed into the inner ear:


The balancing function of the ear can be reduced by an antibiotic that's toxic to the inner ear, and the other ear assumes responsibility for balance. The frequency and severity of vertigo attacks are often reduced by the procedure, which can be performed with local anesthesia in the doctor's office. Anyways, there is a risk of further hearing loss.


In some people, steroids such as dexamethasone may help control vertigo attacks. With local anesthesia by the doctor, this procedure can also be performed. Dexamethasone is less likely than gentamicin to cause further hearing loss, although dexamethasone injections may be slightly less effective than gentamicin.



The hearing of the patient may be improved by using a hearing aid in the ear affected by Meniere's disease. To discuss what hearing aid options would be best for the patient, he/she may be referred to an audiologist.


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