If you are unfamiliar with Meniere’s Disease you are not alone. This is a fairly rare condition that begins with an inner ear disorder resulting in dizziness, hearing loss and ringing in an ear or a sense of congestion. Meniere’s Disease symptoms come and go, usually appearing very suddenly with no warning. These attacks may happen frequently or be separated by weeks or months.
People can develop Meniere’s Disease at any age, but the National Institute on Deafness says that people between the ages of 40 and 60 are at greater risk. As many as 45,500 new cases become diagnosed annually. Those classified with this condition often find it surprising, thinking that their problems had a more specific physical cause.
Meniere’s Disease Causes
While we know that Meniere’s Disease comes from inner-ear dysfunction, that really is a rather broad, non-specific explanation. Those studying Meniere’s feel that fluctuation of the fluids in the inner ear is a key culprit in Meniere’s symptoms. The drainage system in the ear can become blocked or obstructed somehow, increasing pressure in the ear. Some people actually are born with a narrow duct that later contributes to Meniere’s symptoms.
Research shows us that enlarged fluid pathways to the ear drum can create Meniere’s-like symptoms. However there is a difference. People with thin endolymphatic sacs (a part of the inner ear that regulates volume and pressure of inner ear fluids) experience vertigo too. However the same sac in Meniere’s Syndrome patients is fibrous. This really doesn’t help delineate causes but it does help with a firm Meniere’s diagnosis.
Meniere’s Syndrome as an Autoimmune Disease
A great deal of attention has recently been directed at considering if Meniere’s symptoms are part of an auto-immune dysfunction. Reports indicate ties to Thyroid problems, allergies, acute inflammation, rheumatoid arthritis, lupus, and viral infections. Some genotype* studies support this concept.
Genotyping determines the differences in gentic composition by comparing one person’s DNA sequences to another (often a relative or someone who is a control subject in a study.
Over half of Meniere’s Syndrome patients have antibodies indicating some type of immune response.
The connection between head injury and Meniere’s isn’t conclusive. There are certainly cases in which Meniere’s appeared after a trauma, especially those that cause scarring in the inner ear. This is also true of people who experience bone fractures near the temporal lobe.
The science behind the genetics of Meniere’s Syndrome is rather limited. What we do know is that women have higher instances of the disease, as do specific ethic groups (particularly Latino and Caucasians). Studies of families that have manifested with Meniere’s Disease imply that there is some type of recessive inheritance. These families make up about 10% of all diagnosed Meniere’s patients. Successive generations of Meniere’s seem to create more severe symptoms, or expressions at earlier ages.
On average about one person out of three Meniere’s sufferers have a relative who had the disease. It is highly unlikely tho, that Meniere’s can (or will) be traced to one specific gene. There might be as many as fifty fixed chromosomal positions involved.
Allergies and Meniere’s Syndrome
There is evidence that suggests that about 30% of the Meniere’s community has some type of food allergy. The problem here is determining if this influences Meniere’s or is simply another reflection of an immune reaction. The things that alleviate allergies rarely help Meniere’s symptoms at all, which puts the idea of causation at a very low probability.
Microvascular Compression Syndrome
In some cases of Meniere’s Disease, researchers think the symptoms may be caused by a blood vessel irritating the 8th cranial never. Pressure on the nerve results in tinnitus, vertigo, motion sickness, involuntary muscle contractions in the face, and pain in an ear (or throat and tongue). MCS can combine with Meniere’s but needs a separate treatment to alleviate dizzy spells. With this in mind, MCS is probably a Meniere’s imposter that’s misdiagnosed.
Meniere’s Syndrome patients often have antibodies associated with the Herpes virus. Post-mortem exams sometimes find the herpes virus in the inner ear. So researchers believe that latent Herpes, once triggered in a struggling immune system, inflames the inner ear creating issues with fluid drainage. Fluid levels are a huge part of Meniere’s research, so there could be something here worth pursuing further.
Other Theories About the Causes of Meniere’s Syndrome
There are a lot of opinions out there about potential causes of Meniere’s Disease. Some speculate head injuries like TBI may trigger Meniere’s. Other ideas include:
Viral Infection: When a neurotropic virus enters the body, the infection could inflame the inner ear, especially if a person’s immune system isn’t working properly.
Circulation Problems: A fair portion of patients with Meniere’s exhibit decreased blood circulation due to constricted veins in the head and neck. Allaying this problem may reduce some symptoms of Meniere’s. Nonetheless this is most likely a contributor rather than a cause.
Migraines: Meniere’s sufferers are twice as likely to experience vestibular migraines (these start in the inner ear). Even so, the migraine may well be an extension of Meniere’s rather than a cause.
Ear infections: When a doctor asks you about previous ear problems, its because that history is very common in the Meniere’s community. Damage resulting from those infections may impact the development of Meniere’s in the future.
Syphilis: Syphilis presents with symptoms that include progressive deafness, dizziness, headache and vomiting. Studies confirm that between 1-5% or Meniere’s patients have the dual-diagnosis of syphilis.
Meniere’s Disease Triggers
While not an underlying cause of Meniere’s Syndrome there are things that seem to set off an episode for many sufferers. These include:
Stress: Everyone has some level of stress in their lives. As stress occurs our bodies release hormones until the situation passes. The inner ear can detect those hormones and “react” to them, setting off an attack.
Fatigue: Not only do bouts of Meniere’s leave a person exhausted, being tired can also trigger a Meniere’s flare up. When you feel totally lethargic try to get some rest and find ways to slow down the pace of your life a bit.
Emotional ordeals: Your body reacts to emotions by automatic reflex. Some situations make you want to “fight” others “flee”. In either case, those feelings increase your heart and breathing rate. This in turn can lead to vertigo.
Illness: when your body is low on fuel because its focused on an illness, it becomes easier for any auto-immune deficiency to manifest including Meniere’s.
Weather changes: Studies suggest that higher atmospheric pressure decreases the prevalence or severity of a Meniere’s episode. Fast barometric changes seem to be at the heart of this issue. Pay attention to the weather when you have an episode and track it. Find out what conditions effect you the most.
Foods: Food that is high in salt or sugar can increase your water retention. That situation impacts your Meniere’s negatively. Avoid things like honey, high-fructose corn syrup and chocolate.
Alcohol: Drinking can lead to dizziness.
Each individual experiences Meniere’s Syndrome a little differently, making it even harder to discern underlying commonalities and causes.
Meniere’s Disease Symptoms
While we don’t have a full picture of the causes for Meniere’s we do know what the symptoms look like. People with this condition report that they feel uneasy, become more sensitive to sound, have an earache or a headache just before an attack. If a person remains aware of these portents, they can get to a safe, comfortable location in which to wait it out.
What does a Meniere’s Attack look Like?
Immediately a person becomes incredibly dizzy to the point where they might fall down because they can’t get balanced. During this bout of Vertigo hearing aptitude may decrease, ringing in the ears begins (or continues) and the person’s ear feels like its filled with water and that pressure doesn’t subside with common reliefs like yawning or swallowing.
In addition people in a Meniere’s episode may experience heightened anxiety, blurred vision, nausia, vomiting, diarrhea, cold sweats, trembling and heart palpitations. These symptoms leave the Meniere’s sufferer exhausted akin to the weariness that follows seizures. If you have been diagnosed with this condition be aware that Meniere’s takes a toll on your body and you will need rest after incidents.
Meniere’s attacks last for between 20 minutes and 24 hours.
Meniere’s Between Episodes
No matter the cause of Meniere’s, there is no knowing exactly how long it will be before you have another episode. That uncertainty creates a difficult psychological framework. Some sufferers report various personal changes during this “down time” including:
- Stress from fear and anxiety
- Poor coordination
- Appetite increases or decreases
- Minor dizziness
- Minor imbalance
- Stiff neck
- Sound sensitivity
- Vision problems like depth perception or blurred images
Diagnosing Meniere’s Disease
Since we don’t have a definite answer to the question of what causes Meniere’s Disease you may wonder how a physician diagnosis the condition. When your primary care giver suspects you have something going on with your ear that they cannot narrow down, they’ll send you to an Otolaryngoloist (fancy for ear, nose and throat doctor). He or she will ask you a series of questions about what you’ve experienced. These questions include:
- How often do you feel dizzy?
- How long do dizzy spells last?
- Does your dizziness create nausea or vomiting?
- Do you have ringing in your ears?
- Have you experienced any noticeable hearing loss?
- Have you had any injuries to your head or ears?
- Do you have any other diagnosed conditions currently?
- Do your ears feel stuffy?
- How are you sleeping?
- What’s your daily diet like on an average day?
- Have you been experiencing depression or anxiety?
Tests for Meniere’s
There’s no one tried and true test for Meniere’s, but your physician may want to perform a variety of tests that can rule out other conditions and measure the progression of Meniere’s.
Hearing: After gathering a history, the next step may be a hearing test. The doctor wants to see if you have any hearing loss that may be tied to Meniere’s.
MRI or CT Scan: This rules out things like a brain tumor that could create similar symptoms as those associated with Meniere’s.
ECOG: Known as Electrocochleography this measures inner ear pressure which may be higher in Meniere’s Syndrome patients.
VENG: This tests both central motor an dinner ear functions. It also measures eye movements for any abnormalities.
CRP Test: measuring liver function
RPR Test: checking for syphilis
ELISA: For exposure to Lyme Disease
ANA: Measures antibodies in your blood.
With all that alphabet soup you might wonder if all this fuss is necessary. The answer is generally yes. A Meniere’s diagnosis is serious and has a long term impact on your life.The right barrage of tests can confirm or rule out Meniere’s. They may find another issue altogether that causes your symptoms, some of which need immediate attention like TIAs (minor strokes).
Causes of Meniere’s vs. Treatment
In ideal world doctors prefer to treat the cause of a disease. Unfortunately with Meniere’s they have to try and alleviate some of the symptoms instead. Most treatments have a two pronged approach. One is reducing the severity of symptoms, while the other seeks reducing the number of attacks over long-term.
Medications are considered a relatively conservative approach to Meniere’s. One medicine commonly prescribed are water pills to keep you from retaining excess water. The hope is that this also reduces the pressure in the inner ear, which is the main culprit in Meniere’s.
Other medications are those for nausia and vomiting such as Diazepam, Dramamine, and Antivert.
Vestibular Rehabilitation Therapy
Shortened to VRT, this therapy utilizes special exercises that improve a person’s gait and gaze. The main exercises have head movements since that’s the best way to retrain the inner ear’s function.
Injections or Surgery
Approximately 30% of Meniere’s patients do not respond to non-invasive treatments. In this case other strategies come to the forefront. One entails injecting steroids into the ear hoping to decrease inflammation. The other is surgery that either relives pressure in the inner ear, and the other removes the vestibular nerve so it can’t send balance information to the brain. Both surgeries require physical therapy for sometime thereafter.
Meniere’s Syndrome: The Long Game
Meniere’s Disease affects people in different ways. The lucky ones have their symptoms go away and never return. Others end up unable to drive or work due to the severity of their episodes. This is one of the reasons that researchers hope to find some firm underlying causes of Meniere’s as that information could improve the overall prognosis greatly.
Living with Meniere’s
Psychologically it would be much easier to cope with this condition if you knew WHY you had it. The theories about causes presented here give you some ideas, but ultimately the jury is still out on what causes Meniere’s Disease. So, your best bet is finding coping mechanisms.
STEP 1 is perhaps the easiest – self education. Get to know your disease and all its quirks. Once you have sound information you can share it with those in your life’s circle. Most people have never even heard the term Meniere’s, let alone know how it impacts your life on a daily basis.
STEP 2 is adaptation. You will have to make some changes in your life for safety and overall peace of mind. Consult your physician about potential medications and therapy. Review your living and work settings for ways of protecting yourself during onsets of vertigo. Learn about non-medical aids like focusing on one item across the room (this is like keeping your eye on the horizon to avoid sea sickness). Perform self checks before driving or using tools (ie how are you feeling right now?).
STEP 3 Have some personal ground rules. You are NOT your disease so don’t let it become the entire focus of your life. Take control of your condition; don’t let it rule you. Having said that you don’t have to be a rock either. You will have days of wanting to toss up your hands and cry with frustration. That’s normal and actually healthy. Crying is very cleansing. You’ll feel better afterward, and generally have a more optimistic outlook.
STEP 4 Find a good physician who has a background in treating Meniere’s. Also exercise regularly and do everything possible to decrease stresses in your life. Think of this step as part of your self-care plan (while your thinking about it – sketch out that plan!).
Finally, while you wait for science to find the underlying causes for Meniere’s Disease reach out to others in the community who already live with it. Join a support group. Ask questions. Share your struggles and successes. There are all manner of organizations around the world dedicated to sharing information. The Meniere’s Society in the UK and Meniere’s Resources in the US, for example, focus on education, support and raising awareness about Meniere’s throughout society.