Ménière's Disease

Ménière's (or Meniere's) Disease affects about 15 adults in every 10,000 in the UK population. It is a late-onset disease usually starting between the ages of 30-50 years.

Onset in the 60s is less usual while childhood and young adult cases are relatively unusual. For most the onset is sudden and frightening, the predominant symptom being vertigo, a subjective sense of intense rotation of self and/or the environment. Before Prosper Ménière drew attention to the inner ear as the site of the problem, attacks were considered to be apoplectic or epileptic. This gives a measure of the severity of severe attacks.

It is characterised by severe attacks of vertigo combined with progressive deafness and tinnitus. Attacks often start without warning and lead to loss of confidence, anxiety and sometimes depression. Those affected can feel isolated and the effects can impact upon relationships and working life.

Symptoms are variable, though typically include:

• Severe attacks of vertigo lasting up to several hours, with associated nausea, vomiting and sometimes diarrhoea.
• Pressure in the ear(s), tinnitus and a blocked feeling with fluctuating deafness.
• Active spells with attacks spread over several weeks, following by periods without attacks lasting some months.

What is the outlook for those affected?

Typically, those affected will find that, over a number of years, the attacks will become shorter, less severe and, in some cases, may cease altogether.

However, as episodes of vertigo become less frequent, hearing loss often worsens. Although in 85-90% of cases, hearing loss will be restricted to one ear in the early stages, around half of those affected will eventually suffer hearing impairment in both ears. Hearing loss usually increases before, during or following vertigo attacks, though in some cases, the deterioration of hearing can progress independently of attacks.

Some 10% of people with Ménière's have severe and continuing symptoms with short remissions and they may develop serious balance problems as a result of the loss of inner ear function. Some develop 'drop attacks', which can be very worrying.

What causes Ménière's Disease?

The exact cause of Ménière's Disease is unknown, though researchers do have a good understanding of the processes at work in the inner ear. Those affected experience an excessive build-up of fluid within the innermost compartment of the ear, sometimes known as idiopathic endolymphatic hydrops.

In some 7% of those affected there is a family history of the disease, suggesting that some individuals are more susceptible than others. Other factors that have been implicated in triggering active spells include viral infections, allergy, abnormal responses of the immune system and, in many cases, stress.