What is Ménière’s Disease?

Ménière’s disease is a rare condition that affects the inner ear. According to the NHS, around one in 1,000 people in the UK have Ménière’s disease. It’s most commonly found in people aged between 20 and 60, and is thought to affect slightly more women than men (i). One or both ears can be affected: generally it starts in just one ear, but in about four in 10 cases the other ear becomes affected at some stage too (ii).

Ménière’s disease – named after the French physician Prosper Ménière who described the condition during the 1860s – causes sudden and repeated attacks of one or more of the following symptoms:

• Vertigo – a type of dizziness where you feel as if you’re moving or spinning when you’re actually standing or sitting still.

• Tinnitus – where you hear buzzing, hissing, high-pitched whistling or other sounds in one or both ears or the middle of your head (though typically the sound of tinnitus in Ménière’s disease often tends to be low in frequency rather than high pitched).

• Hearing loss in one or more ears (temporary and permanent).

• A feeling of increased pressure inside the ear or ears.

An attack can last anything from 20 minutes to several hours, and you may feel unsteady for one or more days after the attack is over. Some people experience all of the above symptoms during an attack, whereas others may only have vertigo.

Similarly, some have severe symptoms while for others the symptoms can be mild. The frequency of attacks can also vary from one person to another, though it’s thought that someone with Ménière’s disease will experience between six and 11 clusters of attacks a year (ii).
 

Three stages

Ménière’s disease is a progressive condition with an early, middle and late stage – though not everybody with Ménière’s disease conforms to these stages:

• Early stage Ménière’s disease
  In general, most people experience sudden and unpredictable attacks of vertigo during the early stage, often with nausea and vomiting, usually lasting for two to three hours. Some are also affected by hearing loss and tinnitus during an attack, as well as a feeling of fullness in the ear and sensitivity to loud noises. Once the attack is over, their hearing usually returns to normal.

• Middle stage Ménière’s disease
  At this point the vertigo attacks continue, but they can become less severe. Hearing loss and tinnitus, however, can become worse during an attack, and may also continue between attacks along with balance problems.

• Late stage Ménière’s disease
  During the late stage there are usually far fewer vertigo attacks, and they may even stop completely. But hearing loss and tinnitus becomes progressively worse, and balance problems may get worse too.

What causes Ménière’s disease?

Experts still don’t really know what causes Ménière’s disease. However, the most likely explanation is that it’s caused by a problem with the inner ear.

There are three parts to the ear – the outer, middle and inner ear. Also called the labyrinth, the inner ear includes a shell-like structure called the cochlea and the vestibular organ (the vestibular organs in each ear work together and are often referred to as the vestibular system).

Each vestibular organ consists of three narrow tubes called the semicircular canals that sense the movement of the head. By sending signals concerning head movements along the vestibular nerve to the brain, the vestibular organ helps to control your balance and posture.

The cochlea, on the other hand, is concerned with hearing. A small, curled tube filled with liquid and lined with about 15,000 microscopic hairs, it receives vibrations from sound waves passed from the outer and middle ear. These vibrations make the tiny hairs in the cochlea move, which triggers an electrical signal that passes through to the brain via the auditory nerve.

The signal is then transferred to the auditory cortex via neurons within the brain. The auditory cortex recognises and analyses the signal, allowing you to perceive the signal as sound.

Excess fluid

In Ménière’s disease, it’s thought that a build-up of fluid in the inner ear called endolymph triggers abnormal signals to be sent to the brain, causing dizziness and vertigo. Why this endolymph build-up happens isn’t clear, though genetics may play a part (one in 1,000 people have Ménière’s disease among the general population, but about eight out of 100 people with a close relative with Ménière’s disease also develop the condition (iii)).

Other possible causes may include problems with the immune system, a salt imbalance in the inner ear fluid and viral infections of the ear.

A build-up of endolymph may also cause increased pressure on the hearing cells in the inner ear, leading to temporary and ultimately permanent hearing loss. Tinnitus, meanwhile, is thought to be the result of a problem with the cochlea, particularly the hair cell receptors.

The hair cells that are involved with low frequency sounds are thought as those first to be damaged, which may explain why the tinnitus in Ménière’s disease often takes the form of a low, rumbling sound rather than high-pitched hissing, for instance.

Are you at risk?

It’s thought that certain factors may increase your risk of developing Ménière’s disease, including the following:

• A family history of Ménière’s disease.

• Autoimmune problems (some experts believe a third of cases are caused by autoimmunity, where the immune system mistakenly attacks the body’s tissues and organs (iv)).

• Too much or too little sodium or potassium in the body, causing a chemical imbalance in the endolymph.

• Blood vessel problems (such as migraine).

• Viral infections (such as meningitis).

 

Living with Ménière’s disease

If you have Ménière’s disease, being aware of the warning symptoms that signal an oncoming attack can help, especially if you’re out and about and need to move to a safe place. Here are some or all of the things you may experience before an attack starts:

• Problems with balance

• Feelings of dizziness or lightheadedness

• Sensitivity to loud noises

• Headache

• Feelings of pressure inside your ear or ears

• Hearing loss and/or tinnitus

• Feeling uncomfortable or uneasy

If you experience any of these symptoms, try to sit or lie down, especially if you’re feeling dizzy or having vertigo. Avoid sudden movements and bright lights (it may help to lie down in a dark room), and don’t watch TV or try to read. Once the attack is over, don’t try to get back to your normal activities too quickly – you may feel your balance isn’t quite right for some time after an attack, so it’s important to take things easy to prevent having a fall.

There are also a few things you could do to help you cope with Ménière’s disease and even avoid triggering a vertigo attack, including the following:

• Cut down on salt
  A low-salt diet may help to reduce the fluid build-up (aim for less than 6g of salt in your food and drinks each day). Some experts also advise avoiding caffeine, alcohol and chocolate, as these are common migraine triggers (Ménière’s disease and migraines are thought to be linked).

• Avoid stress
  Stress is commonly believed to trigger an attack, so look at ways of reducing your stress levels and relaxing such as using breathing techniques, yoga or meditation. Exercise is an effective way of reducing stress, so try to stay as active as possible between attacks. If you experience prolonged stress, it could lead to anxiety. Read about the symptoms here.

• Quit smoking
  This may also help, as some people have reported giving up tobacco has lessened the severity of their Ménière’s disease symptoms (vi).

Meanwhile, if one of your symptoms is vertigo you may have to avoid situations that could be dangerous if your attacks are sudden, such as swimming, climbing ladders or scaffolding, operating heavy machinery or driving. You also have to inform the DVLA if you have vertigo (vii), and you may not be allowed to drive if your attacks are sudden and you don’t have any warning signs.

Treatments for Ménière’s disease

While there’s no cure for Ménière’s disease, there are treatments used to control the symptoms. Depending on which symptoms you experience during an attack, you may be offered one or more of the following:

Medication

Certain medicines including prochlorperazine and antihistamines such as cinnarizine are prescribed to be taken during vertigo attacks.

Prochlorperazine is a type of medicine called a dopamine receptor antagonist, and is used to control sickness and vomiting. Cinnarizine is prescribed to treat problems affecting the inner ear and balance, and also often used to prevent travel sickness (other antihistamines used to treat vertigo include cyclizine and promethazine teoclate). Both prochlorperazine and antihistamines are best taken at the earliest stage of an attack, as they can stop symptoms from getting worse or make them less severe.

Other medicines used to help prevent vertigo attacks include betahistine, diuretics and beta-blockers.

Vestibular rehabilitation

This technique consists of a series of exercises to help the brain to adapt to movement signals from other parts of your body rather than relying on those coming from your inner ear. This can help reduce dizziness and improve balance. It’s often used in the middle or late stages of Ménière’s disease, when you may have stopped having severe vertigo attacks but you’re still having problems with your balance.

Find out more about vestibular rehabilitation exercises on the Brain & Spine Foundation’s website.

Surgery

If you have severe vertigo during attacks, you may be offered surgery if all other treatments haven’t worked. There are several types of surgery that may help, depending on your symptoms and whether one or both ears have been affected. However, the effectiveness of surgery for Ménière’s disease isn’t fully understood, which is why it isn’t considered an option for most people.

Tinnitus treatments

If you develop permanent tinnitus as a result of having Ménière’s disease, there are several options that may be offered to you, including sound therapy to mask the noise of tinnitus, cognitive behavioural therapy (CBT), tinnitus retraining therapy (TRT) and relaxation therapy. Read our guide to tinnitus to find out more about these.

Hearing loss treatments

There are also treatments for the hearing loss that can accompany the middle or late stages of Ménière’s disease, in the form of hearing aids. Several types of hearing aids are available; your hearing specialist will be able to advise which one would be best for you.

 

Natural support for Ménière’s disease

Giving up smoking and eating less salt are two things you can do to help yourself if you’re affected by Ménière’s disease. There are also two natural supplements that may help with the vertigo that affects people in the early stages of the disease as well as the tinnitus that appears during the later stages.

Ginkgo biloba

This herb is often used to boost blood circulation to the brain and extremities. But it may help relieve the symptoms of vertigo too.

One study suggests ginkgo extract performs better than placebo, with 47 per cent of people taking ginkgo recovering from vertigo symptoms after three months compared with just 18 per cent in the placebo group (viii). Researchers elsewhere claim ginkgo extract is as least as effective as the frequently prescribed anti-vertigo drug betahistine (ix).

Many natural therapy practitioners also recommend ginkgo for tinnitus, with some studies suggesting it may help (x).

Ask your GP for advice before taking a ginkgo supplement if you’re taking any blood-thinning medication, such as aspirin or warfarin.

Ginger

By boosting digestive fluids and neutralising digestive acids, ginger may help relieve the nausea associated with vertigo because it has a calming effect on the gut. Studies also suggest ginger may be useful for relieving various forms of nausea (xi), including motion sickness (conventional treatments for vertigo include motion sickness medicines, with one study claiming ginger is as effective at treating sea sickness as an antiemetic travel sickness drug called dimenhydrinate (xii)).

One small-scale study also found that powdered ginger root reduced induced vertigo significantly better than placebo (xiii). Ginger is also recommended by some natural therapy practitioners to combat tinnitus.

Ménière’s disease can be difficult to identify, but knowing the symptoms can help you get the treatment you need. For more information on common health conditions, visit our dedicated resources in the health library.

 

References:

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

2. Available online: https://patient.info/ears-nose-throat-mouth/tinnitus-leaflet/menieres-disease

3. Available online: https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/menieres-disease

4. Greco A et al., Meniere’s disease might be an autoimmune condition? Autoimmunity Reviews. 2012;11(10):730-8.Available online: https://www.sciencedirect.com/science/article/pii/S1568997212000092
   

5. Available online: https://www.menieres.org.uk/information-and-support/treatment-and-management/other-non-surgical-treatments

6. Available online: https://www.nhs.uk/conditions/menieres-disease/

7. Available online: https://www.gov.uk/dizziness-and-driving

8. Haguenauer. JP, Cantenot. F, Koskas. H, et al. Treatment of balance disorders using Ginkgo biloba extract. A multicenter, double blind, drug versus placebo study [translated from French]. Presse Med. 1986;15:1569-1572. Available online: https://pubmed.ncbi.nlm.nih.gov/2947102-treatment-of-equilibrium-disorders-with-ginkgo-biloba-extract-a-multicenter-double-blind-drug-vs-placebo-study/

9. Sokolova. L, Hoerr. R, Mishchenko. T. Treatment of vertigo: a randomized, double-blind trial comparing efficacy and safety of ginkgo biloba extract EGb 761 and betahistine. Int J of Otolaryngology. 2014:682439. Available online: https://pubmed.ncbi.nlm.nih.gov/25057270-treatment-of-vertigo-a-randomized-double-blind-trial-comparing-efficacy-and-safety-of-ginkgo-biloba-extract-egb-761-and-betahistine/

10. Meyer. B. Multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with Ginkgo biloba extract. Presse Med. 1986;15:1562-1564. Available online: https://pubmed.ncbi.nlm.nih.gov/2947100-multicenter-randomized-double-blind-drug-vs-placebo-study-of-the-treatment-of-tinnitus-with-ginkgo-biloba-extract/

11. Morgenstern. C, Biermann. E. The efficacy of ginkgo special extract EGb 761 in patients with tinnitus. Int J Clin Pharmacol Ther. 2002 May;40(5):188-97. Available online: https://pubmed.ncbi.nlm.nih.gov/12051570-the-efficacy-of-ginkgo-special-extract-egb-761-in-patients-with-tinnitus/

12. Holstein N. Ginkgo Special Extract EGb 761 in Tinnitus Therapy. An Overview of Results of Completed Clinical Trials. Fortschr Med Orig. 2008 May;118(4):157-64.Available online: https://pubmed.ncbi.nlm.nih.gov/11217680-ginkgo-special-extract-egb-761-in-tinnitus-therapy-an-overview-of-results-of-completed-clinical-trials/
    

13. Betz. O, Kranke. P, Geldner. G, et al. Is ginger a clinically relevant antiemetic? A systematic review of randomized controlled trials. Forsch Komplementarmed Klass Naturheilkd. Dec 2005;12:14-23. Available online: https://pubmed.ncbi.nlm.nih.gov/15772458-is-ginger-a-clinically-relevant-antiemetic-a-systematic-review-of-randomized-controlled-trials/

14. Riebenfeld. D, Borzone. L. Randomized double-blind study comparing ginger (Zintona?) and dimenhydrinate in motion sickness. Healthnotes Rev. 1999;6:98-101.

15. Grontved. A, Hentzer. E. Vertigo-reducing effect of ginger root. A controlled clinical study. Otorhinolaryngol Relat Spec. 1986;48(5);282-6. Available online: https://pubmed.ncbi.nlm.nih.gov/3537898-vertigo-reducing-effect-of-ginger-root-a-controlled-clinical-study/

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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