Ménière's disease
Ménière's disease is an uncommon disorder of the inner ear in which attacks of severe spinning dizziness come on together with a drop in hearing and a noise…
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Medicines commonly prescribed for Ménière's disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Towa Pharmaceutical S.A.Prescription not requiredDosage form: TABLET, 650 mg paracetamolActive substance: paracetamolManufacturer: Kern Pharma S.L.Prescription requiredDosage form: TABLET, 650 mg paracetamolActive substance: paracetamolManufacturer: Sun Pharmaceutical Industries (Europe) B.V.Prescription required
Ménière's disease is an uncommon disorder of the inner ear in which attacks of severe spinning dizziness come on together with a drop in hearing and a noise in the ear. An attack arrives without warning, lasts from half an hour to a few hours and settles by itself, and between attacks a person may feel entirely normal. There is as yet no cure, but the course of the illness can be softened a great deal — and, above all, it needs telling apart in good time from conditions that are treated quite differently.
What happens in the inner ear
The inner ear is a bony labyrinth containing a membranous sac filled with fluid called endolymph. One part of it, the cochlea, deals with hearing; the other, the vestibule with its semicircular canals, with balance. Both run on the same fluid, which is why the illness strikes hearing and balance at once.
In Ménière's disease too much endolymph accumulates, pressure inside the labyrinth rises and the membranes stretch. Why this happens is not known for certain: poor drainage of the fluid, an inherited tendency, previous viral infection of the ear, head injury and autoimmune processes are all discussed. In some people it goes hand in hand with migraine, and the two share part of their mechanism.
It almost always begins in one ear, though over the years the other becomes involved in a proportion of people, so hearing on the good side is monitored as well.
What an attack is like
Many people notice a warning: over minutes or a few hours the noise grows louder, the ear feels blocked, and a sense of fullness or pressure builds up inside it. That interval is worth using to get somewhere safe.
The attack itself comes on quickly. The room seems to move and spin, standing and walking become impossible, and nausea, vomiting, cold sweat and a pounding heart often follow. Hearing on the affected side drops at that moment and the noise becomes louder. The typical length is twenty minutes to a few hours; an attack shorter than twenty minutes, or one dragging on for days, points to a different cause.
Afterwards a person is wrung out for a day or two, unsteady on their feet and very sleepy. In the early years hearing returns almost completely between attacks. The attacks themselves come unevenly: several in a month, then half a year of quiet. Over time the dizziness often eases, but in its place come steady hearing loss, a continuous noise and a degree of unsteadiness, particularly in the dark.
Sudden falls
One rare feature of the later stages deserves separate mention: a sudden fall with no warning at all. It feels as though the person has been pushed; they are on the floor at once, do not lose consciousness, and can usually get up again almost immediately. There may be no dizziness beforehand.
The danger lies not in the episode itself but in the injuries: the fall happens on the stairs, by the cooker, in the street. If this has happened even once, tell the doctor specifically. It changes the assessment of the illness, the conversation about driving, and the approach to treatment.
What else it can be
Dizziness is a common complaint and Ménière's disease a rare cause of it, so the first job is to rule out other things.
- Benign positional vertigo: attacks lasting seconds, set off by turning the head or lying down, with no effect on hearing; treated with specific manoeuvres in one or two visits.
- Vestibular neuritis and labyrinthitis: a single long episode of vertigo over several days after a cold, rather than repeated attacks.
- Vestibular migraine: the condition most often mistaken for Ménière's. The dizziness comes with intolerance of light and noise, sometimes with headache, and hearing stays normal.
- A tumour of the hearing nerve: one-sided hearing loss and noise creep up gradually, without dramatic attacks.
- Side effects of medicines, a drop in blood pressure on standing, heart rhythm disturbances, anxiety disorders.
Self-diagnosis from descriptions online is particularly futile here: the symptoms of all these conditions overlap, while their treatments do not.
When an ambulance is needed
Sudden severe dizziness occasionally turns out not to be an ear problem at all but a disturbance of blood flow in the brainstem or cerebellum. Call an ambulance (112 across European countries) if, along with the dizziness, there is:
- drooping of one side of the face, weakness or numbness of the arm and leg on one side;
- slurred speech, difficulty finding words, confusion;
- double vision, loss of part of the visual field, a squint;
- difficulty swallowing, choking on drinks;
- a violent headache that reached full force within seconds, or pain in the neck and back of the head;
- complete inability to stand or sit, with the person keeling over to one side even when held.
An ambulance is also right for dizziness after a blow to the head, and for a high temperature with earache, discharge and a stiff neck. Driving yourself to hospital in that state is not an option.
There is a middle step too. Seek same-day advice if hearing in one ear has dropped sharply over hours or a day: sudden one-sided deafness needs treatment started as quickly as possible, it is counted in days, and lost time cannot be made up later. Same-day advice also applies when vomiting is so relentless that you cannot keep fluids down.
Without urgency, but without putting it off either, see a doctor after the first repeated attacks of dizziness with noise and blocking of the ear.
How the diagnosis is made
The diagnosis is a clinical one, built from the history, the examination and hearing tests. No blood test confirms it, so a detailed account of the attacks — how long they last, how they start, what happens to hearing — is worth more than any machine. The doctor examines the ears and checks balance and eye movements, including after sharp turns of the head, because the pattern of those movements helps separate an ear problem from a brain problem.
The key test is audiometry, a hearing assessment in a soundproofed booth with headphones. In Ménière's disease it shows loss at the low and middle frequencies on the affected side, and those figures shift from visit to visit. It is precisely that fluctuation, captured on repeated audiograms, that forms the main argument for the diagnosis, so the test is repeated and, where possible, done soon after an attack.
The eardrum is checked as well, along with the balance organ, using caloric testing, video recording of eye movements and measurement of muscle responses to sound. An MRI scan is not there to show Ménière's disease but to rule out a tumour of the hearing nerve. Blood tests do not make the diagnosis and are ordered only where another specific cause is suspected, thyroid disease for example.
What to do during an attack
The aim is to get through it safely. At the first warning, stop whatever you are doing and sit or lie down somewhere you cannot fall from a height or end up in the road.
Lying on your side or on your back with the head slightly raised is easiest, in a dim, quiet room. It helps to fix your gaze on a single motionless point and to keep the head still: movement makes the spinning worse.
If your doctor has prescribed something in advance for sickness and dizziness, take it straight away as agreed. Such medicines are carried with you, because during an attack there is no fetching them. They are given in short courses, for the duration of the attack only: taken continuously they stop the brain adapting and make the between-attack unsteadiness worse.
Afterwards get up slowly, and do not drive until the next day even if it feels as though everything has passed.
Treatment between attacks
The aim of treatment is fewer and milder attacks and preserved hearing. It starts with the simplest and safest measures.
The first level is routine. Moderate restriction of salt, drinking steadily through the day, regular meals, a settled sleeping time. Many people find a link between attacks and short sleep, a skipped meal, strong coffee, alcohol and stress; a diary recording the date of each attack and what happened the day before helps pin down your own triggers. Stopping smoking is worthwhile.
The second level is regular medication. Drugs that improve blood flow in the inner ear are commonly prescribed, along with mild diuretics that reduce the volume of fluid in the labyrinth. The doctor tailors these individually; the evidence for them is mixed, so the effect is judged from the attack diary rather than from impressions.
The third level is treatment given through the eardrum when attacks remain frequent. A steroid is injected into the ear and, if that is not enough, an aminoglycoside antibiotic that selectively switches off the balance part of the affected ear. The second option reliably stops the attacks but can worsen hearing, and that is agreed in advance.
The fourth level is surgery: decompression of the endolymphatic sac, division of the balance nerve or, as a last resort, removal of the labyrinth when hearing in that ear has already gone. It is rarely needed. Separate from medicines is vestibular rehabilitation, a set of exercises for the eyes, head and balance. It does not prevent attacks, but it helps the brain adapt and clears the unsteadiness in between.
Hearing, ear noise and mood
Hearing on the affected side eventually settles at a lower level, and that can and should be worked on. A hearing aid is fitted once the loss has stopped fluctuating. Where loss in one ear is profound, there are systems that carry sound across to the good side, and in selected cases a cochlear implant is considered.
The noise in the ear is often more troubling than the deafness itself. It cannot be removed altogether, but it is possible to stop listening out for it: background sound, sound generators, a well-adjusted hearing aid and talking therapy all help.
Mood is not something to keep quiet about. Unpredictable attacks lead people to stop travelling, stop visiting and stop working, and anxiety and low mood follow, which by themselves make the dizziness worse. If your life has visibly narrowed, say so: that help is as much part of treatment as the tablets.
Everyday life
Discuss driving with your doctor separately. While attacks come suddenly and often, you should not be at the wheel; in most countries a driver is obliged to notify the licensing authority about such a condition, and the rules differ from country to country, so check the ones that apply to you.
Review activities in which sudden dizziness is dangerous: swimming alone or out of your depth, ladders and heights, working with machinery or with anything hot, cycling in traffic. At home, simple things help — a non-slip mat in the bathroom, a grab rail, a night light in the hallway, no trailing cables across the floor.
Always keep your prescribed medicines with you. Tell family and colleagues that during an attack you do not need to be taken anywhere; you need help to sit down, dangerous things moved aside, and someone to stay nearby. If your work involves heights or transport, agree with your doctor what restrictions apply during a bad spell.
Online consultation
An online appointment suits going through what is already known: describing the character and length of the attacks, showing audiograms and reports, working out whether the picture fits Ménière's disease or looks more like positional vertigo or migraine, and which tests are worth doing next. Have ready the attack diary with dates and durations, all hearing test results, and the list of medicines you take, since some cause dizziness in their own right.
At follow-up appointments it is convenient to judge whether treatment is working, to discuss how well the drugs are tolerated and to decide whether it is time to move up a level. Bear the limits in mind: eye movements and balance can only be assessed properly in person, and nothing replaces a hearing test done at a distance.
This material is for information only and does not replace medical advice.
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