All about Ménière's Disease

It’s a condition of the inner ear that causes sudden attacks of extreme dizziness, tinnitus, hearing loss and vomiting. The worst thing about the disease is that it’s onset is unpredictable with no real obvious triggers, making the symptoms impossible to prepare for and difficult to manage.

The condition usually starts in one ear, but can spread to both ears over time and Ménière's disease most commonly affects people aged 20-60 (It's uncommon in children). Symptoms vary from person to person, but an attack of hearing loss without vertigo is uncommon. Attacks can occur in clusters or several times a week, or they may be separated by weeks, months or years.

Symptoms, which typically happen all at once can last minutes or several hours, or a full day, but most commonly last two to three hours.

During an attack of Ménière's disease, you may:

Dizziness with a spinning sensation 

Unsteady on your feet

Feel sick or vomit

Hear ringing, roaring or buzzing inside the ear 

Have a sudden drop in hearing

It can take a day or two for the symptoms to disappear completely. You may feel tired after an attack. See your GP if you think you may have Ménière's disease. It can lead to permanent hearing loss if it's not treated.

Treatment

There's no cure for Ménière's disease, but medication can help you control vertigo, nausea and vomiting. The two medicines usually recommended by GPs are:

prochlorperazine – helps relieve severe nausea and vomiting 

antihistamines – help relieve mild nausea, vomiting and vertigo

The aim is to get the medicine into the body as soon as possible at the first sign of any symptoms and, in some cases, it’s a benefit to continue with medication on a daily basis.

There are also a number of support groups, such as the Meniere's Society, that can provide assistance and advice.

What to do during an attack

Vertigo can cause you to lose balance. At the first sign of it:

Take your medication

Sit or lie down 

Close your eyes, or keep them fixed on an object in front of you

Don't turn your head quickly

If you need to move, do so slowly and carefully

If necessary, ask a family member or friend to help you

Once the attack is over, try to move around to help your eyesight and other senses compensate for the problems in your inner ear.

Treating severe attacks

You may be advised to have prochlorperazine as an injection instead of a tablet for quicker action to deal with severe symptoms. In rare cases you may need to be admitted to hospital to receive fluids through a vein to keep you hydrated.

Steroid injections may be help in severe cases, but may only be  considered if other treatments have failed. There are very few clinical trials that have looked at the effectiveness of surgery for Ménière's disease, which is possibly why it's rarely used.

Medication

Your GP may recommend a medication called betahistine to help reduce the frequency and severity of attacks of Ménière's disease. Betahistine is thought to reduce the pressure of the fluid in your inner ear, relieving symptoms of hearing loss, tinnitus and vertigo. There is anecdotal evidence to confirm that if taken as a regular regime this medication can work and keep symptoms at bay, so there is definitely hope for sufferers of this distressing disease.

Foods to avoid

There isn't much proof that changes to your diet can help.

But some people claim their symptoms improve by:

eating a low-salt diet

avoiding alcohol

avoiding caffeine

stopping smoking

Driving and other risks

You can't predict your next attack, so you may need to plan outings more carefully and / or change how you do things to avoid placing yourself or others in danger.

You shouldn't drive when you feel dizzy or if you feel an attack of vertigo coming on.

You must inform the Driver and Vehicle Licensing Agency (DVLA) if you're prone to sudden attacks of vertigo without any warning signs. It's likely that you won't be allowed to continue driving until you have control of your symptoms.

Most people with Ménière's 's disease have no difficulty with flying although if you're worried about vertigo get an aisle seat – you'll be away from the window and will have quicker access to the toilets. Sit away from the plane's engines if noise and vibration are an issue drink water regularly to stay hydrated and avoid alcohol 

Your GP should refer you to see an ear, nose and throat (ENT) specialist to confirm whether or not you have Ménière's disease. The ENT specialist will check you have: vertigo – at least two attacks lasting 20 minutes within a short space of time fluctuating hearing loss – confirmed by a hearing test tinnitus or a feeling of pressure in your ear.

Your GP or specialist may also carry out a general physical examination and blood tests to rule out other possible causes of your symptoms.

Causes

The exact cause of Ménière's disease is unknown, but it's associated with a problem with pressure deep inside the ear. Factors thought to increase your risk include: poor fluid drainage in your ear, an immune system disorder, allergies, viral infection, such as meningitis, family history of Ménière's disease, head injury or migraines. Although it seems likely that Ménière's disease is caused by a combination of factors.

Your GP can offer advice and support if you're finding it difficult to cope with the effect Ménière's disease is having on your life, or check out the The Ménière’s Society - the only registered charity in the UK dedicated solely to supporting people with vestibular (inner ear) disorders causing dizziness and imbalance. The society supports sufferers, their families and carers, helping to improve their quality of life. It also funds vital research into vestibular disorders and works closely with professionals, researchers and organisations to ensure a collaborative approach and raise awareness of these less known conditions.

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Information supplied by NHS and Ménière's sufferer Eve Atkins

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