Vestibular disease
Meniere's disease
This information is intended as a general introduction to this topic. As everyone is affected differently by balance and dizziness problems, you should speak to your doctor for individual advice.
For reasons of better readability, the generic masculine is used and the simultaneous use of the language forms male, female and diverse (m/f/d) is dispensed with. Unless otherwise indicated, the personal designations used in this patient information refer to all genders.

What is Meniere's disease?
Meniere's disease is an inner ear disorder. People who suffer from Meniere's disease experience dizziness, tinnitus and sensorineural hearing loss. Sensorineural hearing loss is the most common form of hearing loss; it is caused by a disorder of the inner ear or the auditory nerve.
Menière's disease is named after Dr. Prosper Menière, a French physician. In 1861, Menière discovered that the ear is the cause of vertigo attacks.
Different people have different symptoms. In addition, the same person can sometimes have mild and sometimes severe seizures. With severe seizures, you are unable to walk.
Meniere's disease is chronic and the course of the disease is progressive. In the later stages of the disease, the attacks of vertigo may diminish or disappear completely. The tinnitus and ear pressure usually remain the same, whereas the hearing loss often worsens over time.
There is no cure for Meniere's disease, but the symptoms can be alleviated.
Researchers are not sure exactly how many people suffer from Meniere's disease. It is possible that one in 200 people is affected, but it may also be much rarer. Meniere's disease is more common in people between the ages of 30 and 60 and affects more women than men.
Summary
- An inner ear disease that can lead to dizzy spells and hearing loss.
- Most seizures last for several hours.
- In most cases, only one ear is affected.
- It is a chronic disease.
- Occurs most frequently in 30- to 60-year-olds.
- Other common symptoms in the affected ear are hearing loss, tinnitus and a feeling of pressure.
- The symptoms during seizures vary from person to person.
- The intensity of the seizures also varies.
- The symptoms and the long-term effects on daily life can be managed with medication and vestibular rehabilitation.
What causes Meniere's disease?
Researchers are not yet sure what causes Meniere's disease. It is likely that it is caused by a combination of different factors. Research in this area is continuing.
Theory: Endolymphatic hydrops
Some researchers believe that Meniere's disease is caused by an accumulation of fluid in the inner ear, known as endolymphatic hydrops. However, some people have endolymphatic hydrops but no symptoms. Other people with endolymphatic hydrops have hearing loss but no vertigo.
Theory: Migraine
Another theory is that Meniere's disease is linked to migraines, at least in some people. Migraines are more common in people with Meniere's disease. It is possible that some people with migraine are wrongly diagnosed with Meniere's disease.
It is likely that Meniere's disease is not a single disease, but a syndrome with many different causes. It may be a reaction of the inner ear to an injury. Researchers suspect a variety of possible causes, including vascular factors, genetic predisposition, autoimmune reactions, viral infections, allergies, trauma, low pressure in the spinal cord, intestinal permeability, acid reflux and venous drainage.
The symptoms of Meniere's disease are
- Spinning vertigo seizures (feeling that the room is spinning), which can last between 20 minutes and 12 hours; most seizures last up to four hours
- Hearing loss and tinnitus in one ear, which may worsen during the vertigo attack
- A feeling of fullness or pressure on the affected ear
Most people only have symptoms in one ear, but over time both ears can be affected.
During an attack, people with Meniere's disease may experience nausea, vomiting and sweating. They may have problems with their gait or posture. Sometimes the seizures occur at very short intervals one after the other. Between attacks, sufferers usually have no or only very mild symptoms.
The symptoms of Meniere's disease can get worse and then get better again. A person can have many seizures in quick succession and then no seizures for years.
In the later stages of Meniere's disease, the dizzy spells may disappear on their own, although sufferers usually have permanent balance problems. The hearing loss can continue to worsen.
Diagnosis of Meniere's disease
There is no test that is "positive for Meniere's disease". The diagnosis is made on the basis of diagnostic criteria. After an initial visit to your GP, you will be referred to a neuro-otologist or ENT specialist. These doctors will take a thorough medical history, perform a neurological examination and various tests to assess the function of your vestibular system.
You will probably undergo some of the following tests:
- General physical examination
- Hearing tests
- Vestibular functional examination
- Balance tests
- Blood tests
- Imaging (CT or MRI scans)
Some of these tests are carried out to rule out other health problems. Several other conditions can cause the same symptoms as Meniere's disease, so the specialist doctor must consider all possibilities before making a diagnosis.
The diagnostic criteria for definitive Meniere's disease are as follows:
- Two or more spontaneous attacks of spinning vertigo, each lasting 20 minutes to 12 hours.
- A sensorineural hearing loss in the low to mid frequency range in the affected ear that occurs at least once before, during or after one of the vertigo attacks. This is measured using a test called audiometry, which measures the ability to hear sounds at different pitches and volumes.
- Fluctuating symptoms (hearing loss, tinnitus or a feeling of fullness) in the affected ear.
- The symptoms cannot be better explained by another vestibular disorder.
The diagnostic criteria for probable Meniere's disease are as follows:
- Two or more dizzy spells, each lasting 20 minutes to 24 hours.
- Fluctuating symptoms (hearing loss, tinnitus or a feeling of fullness) in the affected ear.
- The symptoms cannot be better explained by another vestibular disorder.
Treatment of Meniere's disease
To date, there is no cure for Meniere's disease and the associated hearing loss. However, there are various treatments that can help to alleviate the symptoms of vertigo.
The treatment(s) suggested by your medical team may depend on the following factors:
- your age
- how often and how severe your symptoms are
- whether you also suffer from other illnesses such as migraines, arthritis or allergies
- the state of health of your other ear
The doctor in charge may want to try medication first, especially if your symptoms are only mild. If these do not help, other methods such as ear injections or surgery may be suggested.
It is important to know that Meniere's disease symptoms fluctuate. Sometimes your symptoms will improve on their own for a while. It is therefore difficult to tell whether a particular treatment is working or whether your symptoms just happened to get better at the time you started treatment. This also means that it is more difficult to test suitable treatments for Meniere's disease for their effect.
Researchers know that some treatments for Meniere's disease definitely do not work better than a placebo. A placebo is a comparative treatment and is similar to the therapy under investigation, but has no effect itself.
Therapy option

Diet
People with Meniere's disease are often advised to change their diet. There is little scientific evidence that these changes actually make a difference. However, some people find them helpful and they are unlikely to do any harm. Therefore, you should decide for yourself whether you want to try dieting. The most common dietary changes are:
- a low-sodium (low-salt) diet
- less than 100 mg caffeine per day
- Avoid foods that frequently trigger migraines and can also trigger Meniere's attacks, e.g. monosodium glutamate (MSG), chocolate, red wine, dairy products and pickled foods
Therapy option

Medication
The medications for Meniere's disease include
- Betahistine, which is often prescribed for the treatment of Meniere's disease. Some studies have shown that it could alleviate vertigo attacks. However, the largest study with the highest quality of evidence found that it worked no better than a placebo. It has few side effects in most people and could therefore be tried.
- Diuretics are often prescribed to reduce the accumulation of fluid in the inner ear. There is no convincing scientific evidence for this either. In addition, these drugs have more severe side effects.
- Medication to reduce the severity of dizziness or nausea during seizures, such as antihistamines, dimenhydrinate or, less frequently, diazepam.
Be sure to tell your doctor about any medications you are taking, including vitamins, minerals, herbal remedies or over-the-counter medications. These can sometimes cause side effects or interfere with the effectiveness of other medications.
Therapy option

Ear injections
Compared to diet and medication, the evidence base for more invasive treatments is better. In some treatments, medication is injected through the eardrum as close as possible to the inner ear (transtympanic injections). In most cases, these treatments are carried out in several sessions.
- In some cases, steroid injections can be helpful. The aim of this treatment is to reduce the inflammation. There is evidence that steroid injections reduce the frequency and severity of seizures. There is only a small risk of hearing loss with steroid treatment.
- Gentamicin is an antibiotic that destroys the cells in the vestibular (balance) part of the inner ear. In most cases, patients who receive this treatment no longer have vertigo. However, there is a risk of hearing loss with this treatment. Balance problems may also occur after the treatment. In this case, vestibular rehabilitation can be helpful.
Therapy option

Operation
The evidence base for surgery is also weak. In addition, every operation carries risks and operations on the inner ear, which is located on the brain stem, should be carefully considered.
The following surgical measures are available for the treatment of Meniere's disease:
- Endolymphatic decompression: In this operation, the bone around the so-called endolymphatic sac is removed. The endolymphatic sac drains the fluid from the inner ear. In one study, the symptoms of vertigo improved in around two thirds of patients who underwent this operation. However, about the same number of patients also improved without surgery! One advantage of this operation is that it does not affect hearing. There is a low risk of spinal fluid leaking during this procedure.
- Vestibular neurectomy: During this operation, the vestibular nerve is severed. In most patients, Menière's attacks disappear completely after this procedure. However, it is a major procedure and there is a risk of side effects, such as spinal fluid leakage, infection or stroke.
- Labyrinthectomy: In this operation, the entire inner ear is removed. This operation is therefore usually very successful. However, it also leads to a loss of function of the inner ear, so that it also leads to severe balance disorders and hearing loss. It is usually only performed on older patients or patients who already have severe hearing loss.
Most patients require vestibular rehabilitation after a vestibular neurectomy or labyrinthectomy. Be aware that any invasive form of treatment carries a risk: In about 40% of cases, Meniere's disease will be bilateral (affecting both ears) in the long term. This would lead to bilateral vestibulopathy and more severe impairments.
Therapy option

Vestibular rehabilitation and balance training
Vestibular rehabilitation is an exercise therapy. Its aim is to help your brain relearn balance control. Most people find that this allows them to go about their daily activities with more confidence. However, vestibular rehabilitation cannot prevent future seizures. Vestibular rehabilitation is usually recommended in the later stages of the disease when balance problems occur and persist.
Treatments that do not work
When regular treatments don't seem to work, it's very tempting to try alternative methods. Some treatments are advertised online as "miracle cures". However, there's no point wasting money and time on treatments that don't work. Keep this in mind when thinking about which treatments you want to try.
Various alternative treatments for Meniere's disease have been proposed, including acupuncture, acupressure, neck manipulation, tai chi, hyperbaric oxygen therapy, ginkgo biloba, niacin, ginger root, vitamins, homeopathic remedies and zinc. However, there is no scientific evidence of high quality to support the effectiveness of these treatments.
Studies have also shown that the Meniett device is not effective. With the Meniett device, a small ventilation tube is inserted into the affected ear and the device exerts pulsating pressure on the ear fluid. Two recent analyses of several studies showed that this device does not help against the symptoms of Meniere's disease.
Living with Meniere's disease
The following measures are specifically designed for those affected by Meniere's disease. There are many other general strategies that are useful for dealing with inner ear disease.
Coping with seizures
Since seizures can occur suddenly, it is important to be prepared. Talk to your doctor about what medication you can take in the event of a seizure. Find out which symptoms you should go to hospital for.
Try to do the following during a seizure:
- Lie flat on a firm surface, e.g. on the floor.
- Try not to move your head.
- Try to keep your eyes open and fix your gaze on a fixed object.
- Don't eat or drink much.
- If you are unable to keep fluids down for longer than 24 hours due to vomiting, call an ambulance.
You may feel sleepy after a seizure. It's okay to rest for a short time. However, try to get up slowly as soon as possible and move carefully so that you don't develop a fear of moving.
Let your friends and family know how to recognize an attack and what they can do to help you. Meniere's attacks can last quite a long time, so you should consider a strategy for prolonged care. Share your preferred care plan with friends, family and employers.
Find support
Understanding the disease can help you deal with it. It can be helpful to learn as much as possible about Meniere's disease.
Many people don't know much about Meniere's disease, so you may need to educate your family and friends about it. Let your family and friends know if there are certain things they can do to support you.
Some people find it helpful to talk to other sufferers. Support groups, whether online or in person, can help you share information and tips and reassure you that you are not alone.
What happens next?
What you can expect in the future.
As Meniere's disease is different for everyone, your doctor probably won't be able to tell you exactly what to expect. Some people have mild symptoms and only one or two attacks a year. Other people have severe symptoms and frequent attacks. For many people, the disease follows a pattern of remission and exacerbation, i.e. the symptoms get better for a while and then get worse again.
Meniere's disease changes over time. For many people, the dizzy spells eventually disappear of their own accord. The tinnitus and ear pressure usually remain the same, whereas the hearing loss gets worse. In the later stages of the disease, sufferers may have severe balance problems.
In the later stages of Meniere's disease, some people have attacks where they fall to the ground without warning but do not lose consciousness. These attacks are called tumarkin attacks. The frequency of attacks can vary greatly from person to person. In most cases, the attacks disappear on their own.
Recent studies suggest that high-resolution MRI scans with contrast agent are a promising way to detect endolymphatic hydrops in patients with suspected Meniere's disease and to confirm the final diagnosis. So far, however, most radiology departments are not able to perform this type of examination.
Many researchers have suggested that Meniere's disease is caused by an accumulation of fluid in the inner ear. This results in an imbalance between the production of endolymph in the inner ear and its absorption in the endolymphatic sac. However, some recent research suggests that the endolymphatic sac not only absorbs but also produces endolymph and may therefore be responsible, in part, for too much fluid in the inner ear. This fundamental rethink has led to an experimental surgical technique in which the endolymphatic canal is blocked. In this blockage, a permanent staple is placed on the endolymphatic duct to separate the endolymphatic sac from the rest of the inner ear. Several small studies suggest that this blockade could lead to fewer dizzy spells and improved quality of life in people with Meniere's disease. In the small studies to date, hearing and vestibular function have been preserved. Research into this technique has not yet been completed and therefore, in view of the surgical risks, we would not recommend this technique as a treatment option for the time being.
In order to keep this patient information as short as possible, we have not included a detailed list of references. However, this can be requested at any time at info@ivrt.de.