Meniere’s Disease
What is Meniere’s Disease?
Meniere’s disease is a rare condition that is characterised by a build-up of fluid within the inner ear which then affects hearing and balance functions. It is not yet fully understood what causes this build-up of excess fluid, but it is likely caused by a problem with fluid re-absorption. Within our inner ear, there is a continual process of production and re-absorption of the fluid, called endolymph, which flows within the inner ear and is vital to its proper function. In Meniere’s, it is likely that the impaired absorption of the fluid leads to the build-up, as there is a mismatch between the amount of fluid being produced and the amount being removed.
What are the symptoms of Meniere’s Disease?
Meniere’s disease is characterised by repeated attacks of vertigo (rotary or spinning sensation) that last anywhere between 30 minutes and 24 hours, with associated residual symptoms of dizziness lasting for a further few days or weeks. As well as vertigo, these attacks are usually preceded by a sensation of fullness or pressure in the ear and patients can also experience a temporary impairment of their hearing during the attack. The frequency of these attacks is highly variable, with some patients experiencing an episode once every few weeks and others once every few years. It is important to differentiate Meniere’s disease from other conditions that may also present with repeated attacks of vertigo, such as BPPV and vestibular migraine.
As a patient experiences more and more attacks during their lifetime, there may be a lasting effect on their hearing and balance that leads to more permanent symptoms that do not come and go with the vertigo attacks. These symptoms include hearing loss in the affected ear, dizziness with head movements and impairments of balance.
How is Meniere’s Disease diagnosed?
Within the clinic, there are a series of tests that a vestibular physiotherapist will use to look for evidence of Meniere’s disease. If a patient is experiencing an attack at the time they present for an appointment, careful tracking of their eye movements using an infrared camera will provide evidence of the condition as well as help to localise the affected side. Several other conditions may present with similar findings related to eye movements so other tests will be performed to help with differentiating the diagnosis. Outside of an episode, there may still be findings such as impairments in the way that the eyes move in response to head movements, as well as deficiencies in balance and hearing loss on one side. If Meniere’s disease is suspected the patient will be directed to have further testing, which includes a hearing test and vestibular function testing.
How is Meniere’s Disease treated?
There are several treatment approaches that attempt to reduce the frequency of vertigo attacks associated with Meniere’s disease. A low sodium diet (reducing salt intake) is commonly recommended but evidence for the effectiveness of this approach is not strong. Certain medications can be effective in reducing the frequency of attacks for some patients, most commonly a type of medication called betahistines. In some patients, more advanced forms of treatment such as injections into the ear or surgery may be required.
Vestibular rehabilitation exercises prescribed by a physiotherapist cannot reduce the frequency of the vertigo attacks but do improve balance and dizziness symptoms between these attacks. As described earlier, in patients that have experienced several Meniere’s attacks over time, there may be lasting impairments that significantly affect their everyday life. Vestibular rehabilitation can improve these symptoms by re-training the vestibular system to adapt to these changes and function correctly in an adapted way. For patients who undergo more advanced procedures such as injections and surgery, vestibular rehabilitation is a vital component of their recovery also.
Our vestibular physiotherapist Justin has undergone extensive further training for the rehabilitation of dizziness and balance conditions including Meniere’s.
If you would like to ask Justin a question about Meniere’s or anything else, visit our Contact Us page to get in touch.
If you are ready to make an appointment, visit our make a booking page and let us help you with your recovery.
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