Making Sense of Meniere’s Disease

Dizziness, the inability to hear, and a roaring sound in the ears, presenting separately or as a triad of symptoms, is the world in which a person with Meniere’s disease lives. (11) As a result, this chronic inner ear disorder can lead to permanent hearing loss and significant disruption in quality of life. (2) With this condition, keeping symptoms at bay to help protect and enhance quality of life is a key treatment strategy. The first step in that direction is proper diagnosis.

Meniere’s disease diagnosis

Diagnosing Meniere’s disease can be challenging because it is highly individualized with a symptom profile that can vary from one patient to the next. Some patients may experience a single attack of dizziness infrequently, while others may have several sudden attacks of dizziness frequently over several days or attacks so severe that it causes them to lose balance and fall. (10)

Symptom assessment is important to establishing a diagnosis, especially when it comes to vertigo, which is a whirling sensation that can cause loss of balance. With Meniere’s disease, dizziness episodes can last from 20 minutes to 12 hours, possibly leading to nausea, vomiting, diarrhea, and sweating. (3) These episodes of vertigo are typically accompanied by sensorineural hearing loss, aural fullness, and tinnitus, and patients may also have comorbidities that include migraine or autoimmune illnesses, such as lupus, psoriasis, or rheumatoid arthritis. (7)

While the key Meniere’s disease symptoms include vertigo, hearing loss, tinnitus, and a feeling of fullness in the affected ear, it’s important to rule out other potential causes of these symptoms, including stroke, intracranial tumor, brain infections, or traumatic brain injury, before a diagnosis is made. (13)

Definitive Meniere’s disease diagnosis is characterized by the following:

• Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
• Audiometrically documented low- to medium-frequency sensorineural hearing loss in one ear at least once before, during, or after one of the vertigo episodes
• Fluctuating aural symptoms, including a feeling of fullness, hearing issues, or ringing/roaring in the affected ear
• No other vestibular diagnosis is present (8)

Meniere’s disease causes

According to the National Institutes of Health, the cause of Meniere’s disease is presently unknown, however, genetics and environmental factors likely play a role in its development. (10) Speculation regarding specific causes are debated in the scientific literature and include:

• Abnormal fluctuations with inner ear fluid
• Allergy
• Autoimmunity
• Genetic predisposition
• Hormonal mechanisms (8)

As the underlying etiology is difficult to discern with Meniere’s disease, there is presently no known cure, and treatment revolves around avoidance of triggers and symptom management.

Meniere’s disease triggers

Triggers for this condition, which can be varied and extensive, include:

• Atmospheric pressure
• Blood pressure changes
• Crowd noise or sharp noises
• Dairy, chocolate, caffeine, or alcohol
• Head position or quick head movements
• Meal timing
• Physical exertion or tension
• Salt intake
• Seasonal or windy weather
• Stress
• Tiredness
• Traveling by car, bus, train, boat, or airplane
• Visual environments such as reading, looking at water or bright lights, or watching TV (5)

Meniere’s disease treatment

Prioritized in the following order, Meniere’s disease treatment focuses on preventing or reducing the severity and frequency of the following symptoms:

1. Vertigo
2. Hearing loss
3. Tinnitus
4. Aural fullness

By achieving these clinical goals, improvement will be seen in the quality of life for a person diagnosed with Meniere’s disease. (1)

A common conventional medical intervention with Meniere’s disease is the use of diuretics which are believed to reduce fluid in the inner ear; however, in some cases, corticosteroids or betahistine may be prescribed to help with vertigo. (3) The antibiotic gentamicin and surgery are also conventional medical treatment options used to help decrease symptoms of vertigo. (9)

Interventions that can help treat Meniere’s disease included identifying and avoiding the symptom triggers outlined above, as well as achieving relief using specific dietary and lifestyle modifications.

Meniere’s disease lifestyle

Avoiding triggers is a big part of the lifestyle focus but there are other lifestyle factors that can make a difference. Patients with Meniere’s disease often benefit from:

• Focusing on both the quantity and quality of sleep each night
• Proactively managing stress
• Sleeping in a dark room to protect circadian rhythm
• Staying well hydrated by drinking fresh water throughout the day (6)

Dietary modifications are considered first-line treatment for this condition with a primary focus on salt, caffeine, and alcohol.

Meniere’s disease diet

Diet can make a big difference when it comes to the quality of life and symptom management for patients diagnosed with Meniere’s disease. The most effective Meniere’s disease diet includes adhering to a low-salt diet, consuming an abundance of water, reducing or avoiding alcohol and caffeine, and following a gluten-free diet. (4)

In many cases, specific dietary modifications can result in significant positive effects. (4)

The bottom line

Meniere’s disease can be difficult to diagnose, and because there is no clear cause, treatment can be even more complex. Through an integrative dietary and lifestyle approach, patients with Meniere’s disease can achieve symptom relief and a better quality of life.