COMMON VESTIBULAR ISSUES
Meniere's Disease Treatment Melbourne
The Vertigo Co will assess your symptoms and provide tailored treatment options.
The Vertigo Co
What is Meniere’s Disease?
Meniere’s Disease, also known as Endolymphatic Hydrops, is a chronic disease of the inner ear that occurs as a result of abnormally large amounts of fluid, called endolymph, collecting in the inner ear. This places pressure on the vestibular (balance organ) and the auditory systems, resulting in the various symptoms of Meniere’s (1).
Are you experiencing Meniere’s Disease symptoms? For a detailed assessment and treatment options, get in touch with us today.
Meniere’s Disease Symptoms
Meniere’s Disease looks different for each person. For some it may develop slowly over time with gradual hearing loss, while for others it may start suddenly with an attack of vertigo. These attacks are common in the early to mid stages of the disease and may last from 20 minutes up to 24 hours.
The most common symptoms of Meniere’s Disease include(1):
Vertigo (an illusion of movement or spinning)
Nausea &/or vomiting
Hearing loss and tinnitus (ringing in the ears)
Aural fullness (a feeling of fullness/pressure in the ear)
Other symptoms include anxiety, palpitations, cold sweats and diarrhoea.
Some people with Meniere’s Disease find their symptoms are made worse by certain events or situations called triggers. These triggers may include:
Dietary issues (caffeine, alcohol or high sodium diet) (2)
Stress (3)
Fatigue
Pressure changes (4)
Meniere’s Disease
What are the Stages of Meniere’s Disease?
Meniere’s Disease typically affects only one ear, although it is common for the second ear to be affected as well in the later stages of the disease. Over that time, hearing loss can slowly become permanent. But it is also common for vertigo attacks to eventually diminish or stop.
Stage One (early):
Intermittent attacks of Vertigo lasting 20 minutes to 24 hours.
Fluctuating mid to low frequency hearing loss
Tinnitus in the affected ear
Aural fullness in the affected ear
There are usually periods of remission (symptom-free periods) between episodes
Stage Two (intermediate):
Vertigo attacks continue, however the patient may experience imbalance or movement related dizziness between episodes.
Permanent hearing loss and tinnitus develops in the affected ear.
Stage Three (late or “burn out” Menieres):
Vertigo attacks dimmish or stop.
Hearing loss can be severe.
Tinnitus and Aural fullness continue.
50% of sufferers may develop Meniere’s Disease in the opposite side.
What Causes Meniere's Disease?
The exact cause of Meniere’s Disease is not yet known.
Many theories have been proposed including circulation problems (5); a viral infection (6); allergies (7); an autoimmune reaction in 1/3 of cases (8); Migraine (9); and the possibility of a genetic connection (10).
Underlying causes aside, experts also aren’t sure yet what generates the symptoms of Meniere’s Disease. The leading theory is that they result from increased pressure in the ear caused by an abnormally large amount of endolymph in the inner ear, and/or from the presence of potassium in the inner ear where it does not belong. Approximately 25% of Meniere’s Disease patients will have coexisting Vestibular Migraine (17).
Meniere’s Disease
How Is It Diagnosed?
Meniere’s Disease is diagnosed based on your symptoms and thorough medical history, along with specific tests for this condition.
These tests may include an Audiogram (hearing test) to confirm the presence of fluctuating mid-to-low frequency hearing loss, a characteristic feature of Meniere’s Disease. They may also involve Vestibular Function Testing (VFT) for a more-in-depth analysis of your inner ear function.
Tests like this not only help medical professionals detect the presence of Meniere’s but also monitor the progression of the disease.
If you have symptoms of Meniere’s Disease, a vestibular physiotherapist can undertake an assessment and advise you whether you require further testing. Book an appointment with our team to get started.
Meniere’s Disease
How Is It Treated?
There is no cure for Meniere’s Disease, but a number of treatments are available that assist with the management of this condition.
Medication
One form of medication commonly prescribed for Meniere’s Disease is Betahistine (Serc), which is thought to improve blood flow around the inner ear and therefore decrease fluid. There is currently insufficient evidence to determine the effectiveness of Serc for Meniere’s Disease, however many clients find it useful (11, 12). Other medications may also be prescribed for use during a Meniere’s attack, including anti-emetics such as Stemetil or Ondansetron to reduce nausea and vomiting, and Valium to help suppress the vestibular system.
Dietary Changes (13)
Symptoms of Meniere’s Disease result from having too much fluid in the inner ear, hence a diet to reduce fluid in the inner ear is thought to help reduce symptoms. Dietary changes often include:
- Low sodium diet (salt): Eat food with no more than 120mg/100g of sodium (or no more than 1000mg of sodium per day)
- No caffeine: remove foods such as tea, coffee, cola and chocolate
- No Alcohol
Vestibular Rehabilitation
It must be stated that physiotherapy is unlikely to prevent bouts of Meniere’s Disease from occurring and can be limited in its effectiveness due to the fluctuating nature of the condition. However, some patients do find remission from Meniere’s with vestibular physiotherapy. In conjunction with medication, vestibular rehabilitation exercises may be provided to help the brain adapt to the altered signals resulting from Meniere’s Disease, in a process called compensation. These exercises may be designed to stabilise vision, to help desensitise the body to movement, or to help restore your balance (14, 15). Your physiotherapist will prescribe these exercises based on a comprehensive assessment.
Surgery
For patients who do not respond to conservative management of medication and diet, surgery may be recommended.
The surgical procedures available include:
- Trans-tympanic Ventilation Tubes (Grommets): The insertion of grommets has been shown to be an effective treatment strategy in relieving the symptoms of Meniere’s when accompanied by trans-tympanic steroid injections.
- Gentamicin ablation: An antibiotic that is toxic to the vestibular system is injected into the ear to ablate the vestibular system (16). After injection, sufferers will require a period of vestibular rehabilitation to recover from damage to the system.
Your physiotherapist may also recommend counselling sessions to help you deal with the stress, anxiety and grief that can often be associated with Meniere’s Disease.
Resources
- Vestibular Disorders Association (VEDA) Website https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/menieres-disease/
- Dr. Timothy Hain (Vestibular neurologist, University of Chicago) offers extensive educational information at https://dizziness-and-balance.com/disorders/menieres/menieres.html
- Meniere’s Society UK https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/menieres-disease
- Julia, a fellow Meniere’s suffer has lots of information on her Instagram @managing.menieres
Frequently Asked Questions
There is no cure for Meniere’s Disease. Instead, treatment is focused on managing symptoms and reducing Meniere’s attacks through a range of non-surgical and surgical treatments. The non-surgical treatments include medication, Vestibular Rehabilitation Therapy, and lifestyle decisions such as dietary changes and stress management for example.
Meniere’s Disease is not a life-threatening condition, and will not impact your life expectancy. However, it is a progressive disease, which means it is likely to worsen over time. By the late third stage, your vertigo attacks may have diminished but your hearing problems may be more severe, and the balance organs in your inner ear will likely have suffered permanent damage. Some people will also experience anxiety or depression as a result of the challenges of navigating the disease. However, several treatment options are available that can help you maintain a high quality of life, with only the occasional vertigo attack or other symptom.
Your first appointment will last between 45-60 minutes and will include an assessment with a physiotherapist for Meniere’s Disease or other vestibular disorders. Once a cause for your symptoms has been determined, your physiotherapist will tailor a specific treatment program for your needs. If they believe your symptoms require further investigation, you may be referred to a specialist service, including a Vestibular Audiologist for Vestibular Function Testing (VFTs) or a Neuro-Otologist.
Meniere’s Disease involves a range of symptoms also connected to other conditions, including other vestibular disorders like Benign Paroxysmal Positional Vertigo (BPPV) and Vestibular Migraine. These symptoms include vertigo, dizziness, nausea and vomiting. If you are experiencing any of these symptoms on a frequent or chronic basis, please seek advice from our physiotherapists or other trusted medical professionals.
The Vertigo Co
Contact Us For Quality Care
If you think you might have Meniere’s Disease, there is support available. Our highly experienced team can ensure your questions are answered and connect you with personalised assessment and treatment options.
For more information or to book an appointment, contact us today.
the Vertigo Co
References:
- Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, et al. Meniere’s disease. Nature Reviews Disease Primers. 2016;2(1):16028. https://pubmed.ncbi.nlm.nih.gov/27170253/
- Christopher LH, Wilkinson EP. Meniere’s disease: Medical management, rationale for vestibular preservation and suggested protocol in medical failure. American Journal of Otolaryngology. 2021;42(1):102817. https://pubmed.ncbi.nlm.nih.gov/33202330/
- Soderman ACH, Moller J, Bagger-Sjoback D, Bergenius J, Hallqvist J. Stress as a trigger of attacks in Meniere’s disease. A case-crossover study. Laryngoscope. 2004;114(10):1843-8. https://pubmed.ncbi.nlm.nih.gov/15454783/
- Schmidt W, Sarran C, Ronan N, Barrett G, Whinney DJ, Fleming LE, et al. The Weather and Ménière’s Disease: A Longitudinal Analysis in the UK. Otol Neurotol. 2017;38(2):225-33. https://pubmed.ncbi.nlm.nih.gov/27861300/
- Gussen R. Vascular Mechanisms in Meniere’s Disease: Theoretical Considerations. Archives of Otolaryngology. 1982;108(9):544-9. https://pubmed.ncbi.nlm.nih.gov/7052032/
- Arnold W, Niedermeyer HP. Herpes Simplex Virus Antibodies in the Perilymph of Patients With Meniere Disease. Archives of Otolaryngology–Head & Neck Surgery. 1997;123(1):53-6. https://pubmed.ncbi.nlm.nih.gov/9006503/
- Derebery MJ. Allergy and Meniere’s disease. Current Allergy and Asthma Reports. 2007;7(6):451. https://pubmed.ncbi.nlm.nih.gov/17986376/
- Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M. Meniere’s disease might be an autoimmune condition? Autoimmunity Reviews. 2012;11(10):731-8. https://pubmed.ncbi.nlm.nih.gov/22306860/
- Radtke A, Lempert T, Gresty MA, Brookes GB, Bronstein AM, Neuhauser H. Migraine and Ménière’s disease. Is there a link? 2002;59(11):1700-4. https://pubmed.ncbi.nlm.nih.gov/12473755/
- Morrison AW, Bailey MES, Morrison GAJ. Familial Ménière’s disease: clinical and genetic aspects. The Journal of Laryngology & Otology. 2009;123(1):29-37. https://pubmed.ncbi.nlm.nih.gov/18616841/
- Lacour M, van de Heyning PH, Novotny M, Tighilet B. Betahistine in the treatment of Ménière’s disease. Neuropsychiatr Dis Treat. 2007;3(4):429-40. https://pubmed.ncbi.nlm.nih.gov/19300572/
- Van Esch B, van der Zaag-loonen H, Bruintjes T, van Benthem PP. Betahistine in Meniere’s Disease or Syndrome: A Systematic Review. Audiology and Neuro-Otology. 2021. https://pubmed.ncbi.nlm.nih.gov/34233329/
- Luxford E, Berliner KI, Lee J, Luxford WM. Dietary Modification as Adjunct Treatment in Meniere’s Disease: Patient Willingness and Ability to Comply. Otology & NeuroOtology. 2013;34(8):1438-43. https://pubmed.ncbi.nlm.nih.gov/23965526/
- Gottshall KR, Hoffer ME, Moore RJ, Balough BJ. The Role of Vestibular Rehabilitation in the Treatment of Meniere’s Disease. Otolaryngology – Head and Neck Surgery. 2005;133(3):326-8. https://pubmed.ncbi.nlm.nih.gov/16143175/
- Clendaniel RA, Tucci DL. Vestibular Rehabilitation Strategies In Meniere’s Disease. Otolaryngologic Clinics of North America. 1997;30(6):1145-58. https://pubmed.ncbi.nlm.nih.gov/9386249/
- ödkvist LM, Bergenius J, Möller C. When and How to Use Gentamicin in the Treatment of Meniere’s Disease. Acta Oto-Laryngologica. https://pubmed.ncbi.nlm.nih.gov/9107358/ 1997;117(sup526):54-7.
- Chen JY, Guo ZQ, Wang J, Liu D, Tian E, Guo JQ, Kong WJ, Zhang SL. Vestibular migraine or Meniere’s disease: a diagnostic dilemma. J Neurol. 2023 Apr;270(4):1955-1968. https://pubmed.ncbi.nlm.nih.gov/36562849/