What is endolymphatic hydrops?

Endolymphatic hydrops or cochlear hydrops – or more simply, ear hydrops – is a disorder of the vestibular system in the inner ear. Hydrops is a word that describes excessive fluid build-up in tissues or cavities of the body. In the ear, the fluid in question is called endolymph.

The vestibular system is also sometimes called the vestibular organ. It’s made up of passages and chambers in your inner ear (labyrinth), including three narrow tubes located at right angles to each other called the semicircular canals and two sacs called the utricle and the saccule. These tubes sense your head movements and send signals about those movements along the vestibular nerve to your brain, which helps control your balance and posture.

The vestibular system’s tubes and sacs are filled with endolymph, with another fluid called perilymph found outside them. Both of these fluids contain water and electrolytes (minerals that carry an electrical charge) including sodium, potassium and chloride.

However each has a different chemical composition: for example, endolymph is rich in potassium with very little sodium, whereas perilymph is rich in sodium and low in potassium. When these fluids become out of balance – either in terms of how much fluid there is or the chemical make-up of the fluids (or both) – the tubes and sacs of the vestibular system become inflamed (swollen) and the inner ear cannot work properly.

Meanwhile the cochlea – a small, curled tube filled with fluid and lined with thousands of microscopic hairs – isn’t part of the vestibular system but it is also found in the inner ear. The cochlea is the hearing component of the inner ear, and receives vibrations from sound waves from the outer and middle ear, transmitting them to the brain via the auditory nerve. It too is filled with endolymph, and if there are any abnormal fluctuations in the cochlea’s fluid pressure the result is inflammation, which can distort sound information going to the brain.

What are the endolymphatic hydrops symptoms?

If you have endolymphatic hydrops you’ll usually experience symptoms including lightheadedness, lack of balance and unsteadiness, vertigo (dizziness with the sensation that everything around you is moving, whirling or spinning), tinnitus, hearing lossthat comes and goes as well as a feeling of fullness or pressure in the affected ear or ears (both ears may be affected in up to 20 per cent of cases (i)).

Vertigo can be particularly unpleasant, and with endolymphatic hydrops it may last for just a few minutes or as long as a few hours. It can also be accompanied by nausea and vomiting, so when you’re having an attack you may not be able to carry on with your usual activities. You may feel tired for a while afterwards too, and a feeling of being off-balance may stay with you for several days. Vertigo attacks may also happen without warning, which can be very disabling.

Tinnitus – hearing buzzing, hissing or other sounds in one or both ears or in the middle of your head – can be constant or intermittent in people with endolymphatic hydrops (find out more about this uncomfortable condition by reading our tinnitus guide). The hearing loss experienced with endolymphatic hydrops can also come and go, but you could develop longer-lasting or possible even permanent hearing loss in time. Meanwhile the sensation of fullness or pressure within the ear is caused by increased fluid pressure, and cannot be cleared when you try to ‘pop’ your ears.

All of these are also symptoms of Ménière’s disease. In fact, Ménière’s disease is another name for primary idiopathic endolymphatic hydrops. This is one of two types of endolymphatic hydrops, the other being secondary endolymphatic hydrops:

• Primary endolymphatic hydrops is idiopathic, which means there’s no known reason why it happens. If you’ve been diagnosed with Ménière’s disease, you will usually have endolymphatic hydrops too – however not everyone with endolymphatic hydrops has (or will progress to) Ménière’s disease.

• Secondary endolymphatic hydrops is caused by an injury – such as head trauma – or another condition, including allergies and autoimmune disorders.

Other vestibular disorders

The symptoms of endolymphatic hydrops are also found in other disorders of the vestibular system, including the following:

Benign paroxysmal positional vertigo (BPPV)

According to the Vestibular Disorders Association in the US, BPPV is the most common cause of vertigo (ii). It develops when crystals from the utricle in the inner ear move into and build up in one or more of the semicircular canals, causing episodes of vertigo that are triggered when you move your head in certain ways (when looking up, for instance) or when you stand up, bend over or turn over in bed. BPPV is often treated by doing certain movements and exercises that can relieve symptoms for a week or two.

Labyrinthitis

Caused by an infection that affects the inner ear and both branches of the vestibulo-cochlear nerve, this can cause symptoms such as vertigo, dizziness and problems with vision, balance and hearing.

Vestibular neuritis

Also an infection of the inner ear, vestibular neuritis only affects the branch of the vestibulo-cochlear that affects balance, so the symptoms include dizziness and vertigo but not problems with hearing.

Acoustic neuroma

This is a non-malignant tumour that develops on the vestibulo-cochlear nerve. As it grows it pinches the nerve, which can lead to hearing loss, tinnitus, balance problems and dizziness.

Migraine-associated vertigo

According to the Vestibular Disorders Association, around 40 per cent of people who have migrainesexperience problems with balance or dizziness at some point too (iii) – whether before, during, after or independent of having a migraine. Migraine-associated vertigo is also sometimes called vestibular migraine.

Ménière’s disease or primary endolymphatic hydrops

We may not have any official statistics for how many people in the UK are affected by endolymphatic hydrops overall, but according to the NHS around one in 1,000 people in this country has Ménière’s disease, or primary endolymphatic hydrops (iv).

The exact cause of Ménière’s disease isn’t known, though there are several theories as to things that may trigger it in some people including viral infections, allergies, genetics, autoimmune reactions, migraine and circulation problems. Experts are divided on what causes the symptoms too, though most believe they’re triggered by an abnormal build-up of endolymph in the inner ear.

What are the symptoms of Ménière’s disease?

Symptoms of Ménière’s disease tend to appear in a specific pattern of progression:

• Ménière’s disease often starts with sudden and unpredictable vertigo attacks, often with nausea and vomiting. Some people also experience intermittent hearing problems and tinnitus during the early stages too, as well as a feeling of fullness in their ear.

• During the next stage vertigo can become less severe, though hearing loss and tinnitus can become more severe and more long lasting. Balance problems may start during this stage too.

• The late stage of Ménière’s disease usually causes fewer vertigo attacks – or even no vertigo attacks at all – but hearing, tinnitus and balance issues can become even worse.

There is currently no cure for Ménière’s disease, but the good news is there are treatments that can help you manage some of the symptoms as well as lifestyle changes that can make life easier.

For more information on living with Ménière’s disease, including treatments and lifestyle and natural support for the condition, take a look at What is Ménière’s disease?

Secondary endolymphatic hydrops

Changes in the volume and/or composition of endolymph in the inner ear can also have a known cause, in which case the condition is known as secondary endolymphatic hydrops.

There are various things that are thought to be possible triggers for secondary endolymphatic hydrops, including:

• Trauma to the ear caused by an injury

• Trauma to the ear caused by loud noises such as explosions or gunshots (acoustic trauma)

• Having surgery that affects the inner ear (having a cochlear implant installed, for instance, or a procedure called ablation of the endolymphatic sac, which helps drain fluid from the inner ear)

• Taking medicines that affect the amount of fluids in the body

• Tumours, or acoustic neuromas, in the inner ear

• Ear infections (otitis media - or middle ear infections – for instance, or labyrinthitis)

• Other infections that cause inflammation

• Allergies

• Autoimmune conditions including type 1 diabetes

The symptoms of secondary endolymphatic hydrops are similar to those of Ménière’s disease, namely pressure or fullness in the ears, dizziness, imbalance, tinnitus and hearing problems. However, there isn’t a noticeable progression of symptoms as there is with Ménière’s disease. Also, where appropriate, treating the underlying cause of secondary endolymphatic hydrops symptoms typically helps to clear them up (though it may take up to a couple of years before the symptoms stop altogether, depending on what’s causing them).

Endolymphatic hydrops treatment

If you’ve been diagnosed with endolymphatic hydrops, your doctor or specialist may recommend a course of treatment to help manage the symptoms. This can include medicines such as diuretics (water pills) to reduce the fluid build-up in the ear, antihistamines and medicines that help reduce the severity of vertigo and nausea. If your symptoms don’t respond to medicines and your vertigo is severe, your specialist may recommend surgery to try and control it.

How to support yourself

There are, however, lots of things you can do yourself to improve and maintain your quality of life with endolymphatic hydrops:

How to support yourself

Eating a healthy balanced diet will help improve and maintain your health overall, but there are some other things you could consider if you have endolymphatic hydrops, as they may help you manage some of your symptoms:

• Choose foods and drinks that are low in salt and sugar – eating as many fresh foods as possible and avoiding processed foods will help. A low-salt, low-sugar diet may help reduce dizziness.

• Try to drink plenty of fluids to stay hydrated. Opt for water, milk, herbal teas and well-diluted fruit juice while avoiding caffeinated drinks like tea, coffee and caffeinated, sugary soft drinks (steer clear of chocolate too, which also contains caffeine). Try to limit how much alcohol you drink or stop drinking it altogether if you can.

• Eat and drink regularly and try not to skip meals. According to the Vestibular Disorders Association spacing your food and fluid intake evenly may help with inner-ear fluid stability (v). If you have snacks during the day, try to have them at the same time too.

Try supplements

You may also want to consider taking one or more nutritional supplements to make sure you’re getting the range of nutrients your body needs, not just for coping with your condition but for maintaining your health in general. A good-quality multivitamin and mineral supplement is a great place to start, as it will cover all your nutritional bases.

Meanwhile supplements that help reduce inflammation could be useful too, such as high-strength fish oil capsules. Indeed, the omega-3 fatty acids found in oily fish are widely thought to have an anti-inflammatory effect, with one study suggesting they’re not just effective but that they also lack the side-effects of conventional anti-inflammatory medicines (vi).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3 (this is sourced from marine algae rather than from fish).

Limit some medicines

Aspirin may not be as popular as it once was, arguably because it can cause problems with gastric bleeding, but if you still take it try not to use it too often. That’s because aspirin in high doses is thought to potentially cause temporary tinnitus. You may also want to limit some anti-inflammatory drugs, including painkillers such as ibuprofen, as there’s a chance they could affect your fluid balance. Also make sure any medicines you’re taking don’t contain caffeine (ask your GP or pharmacist for advice if they do). Another thing to look out for is the amount of salt in some medicines, such as indigestion medicines called antacids – again, ask your GP or pharmacist to recommend the best low-salt option for you.

Give up smoking

If you’re a smoker, giving up could make a difference to your symptoms because smoking may affect blood supply to your ears. Try using a stop smoking aid if you need help with managing nicotine cravings – there are plenty available, including patches, lozenges and gum. For more help with giving up smoking, take a look at our guide.

Tackle stress

Living with a condition such as endolymphatic hydrops can be stressful. But having too much stress in your life could make your symptoms worse. Learn ways of managing your stress levels can help, including finding things that help you feel more calm and relaxed. There’s more information about combatting stress in our guide to stress symptoms and signs.

Support your immune system

If you have endolymphatic hydrops as a result of an infection, it’s a good idea to keep your immune system as healthy as possible to help it fight the infection off. There are lots of ways to do this, from eating immune-boosting foods to taking regular exercise, getting plenty of sleep and trying nutritional supplements – to find out more, read our guide How can you strengthen your immune system?

Endolymphatic hydrops can make life a challenge, especially if you have symptoms that come on suddenly and without warning. The good news, however, is there’s lots you can do to improve and maintain your quality of life. To find out more about a wide range of health conditions and how you can help yourself, visit our health library.

References:

1. Available online: https://www.entad.org/wp-content/uploads/2016/03/ENDOLYMPHATIC-HYDROPS.pdf

2. Available online: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

3. Available online: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/

4. Available online: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/menieres-disease

5. Available online: https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/dietary-considerations/

6. Maroon . JC., Bost JW., Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. Available online: https://www.sciencedirect.com/science/article/abs/pii/S0090301905007743?via%3Dihub

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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