What is Meniere’s Disease?

Jul 28

Meniere’s disease is a condition which causes episodic vertigo and dizziness. It creates a sensation of spinning or falling. It often comes paired with the sensation of pressure or fullness in one or both ears. It can create balance difficulties and a general sensation of unsteadiness, and at times may provoke a sudden sensation of severe vertigo. Meniere’s Disease can be an extremely challenging and frustrating condition to live with.

How Common is Meniere’s Disease?

Meniere’s Disease affects approximately 615,000 people a year in the United States. While this renders it a relatively rare disorder impacting only 0.2% of the population, we see it quite commonly in our practice (1). It appears to be roughly equally distributed between women and men, and is most common around age 60 (2).

What are the Symptoms of Meniere’s Disease?

Symptoms of Meniere's disease include:

Recurring episodes of vertigo. A Meniere’s attack involves spinning sensation that appears to start and stop spontaneously. Attacks occur without warning and can last from several minutes to several hours. The vertigo an attack produces can be severe and produce nausea and vomiting.
Hearing loss. Hearing loss in Meniere's disease may initially be episodic, but as the disease progresses most people develop some permanent hearing loss, usually of low frequencies.
Ringing in the ear (tinnitus). Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear. As the disease progresses this grows louder.
Feeling of fullness in the ear. People with Meniere's disease often feel pressure in an affected ear (aural fullness).

After an episode, signs and symptoms improve, however people usually have some form of residual symptoms of dizziness, balance difficulty, or fatigue that persist for several weeks. After multiple episodes these symptoms may become permanent (15).

What Causes Meniere’s Disease?

The cause of Meniere’s disease has not been fully established. Genetic, autoimmune and traumatic factors may all play a role to one extent or another. The consequences of Meniere’s Disease are more readily understood, as an abnormal level of fluid accumulates inside the chambers of the inner ear. Factors shown to affect these fluid levels include diet, viral infection, abnormal immune response, poor drainage, and possible genetic predisposition (3).

What Happens in the Inner Ear with Meniere’s Disease?

The problems of Meniere's disease are largely caused by a process known as endolymphatic hydrops. These two terms are often interchangeably used however it is important to understand that if you have endolymphatic hydrops, you may not experience all of the symptoms of Meniere’s Disease. The relationship between endolymphatic hydrops and Meniere's disease is still being established (4).

The inner ear contains receptor systems known as Semicircular Canals. These are membranous fluid-filled tubes that in one region are lined with specialized hair cells that function as vestibular receptors. The fluid is dense, like seawater. When the head moves, the inertia of the fluid results in it taking a moment to start to move. This causes the hair cells to bend, which stimulates the vestibular nerve. This conducts impulses to the brainstem, cerebellum, and brain. These impulses serve to tell the brain about the direction of head movement.

The semicircular canals contain two fluid filled compartments separated by a membrane. One compartment contains Endolymph, a fluid high in potassium and low in sodium, and the other contains Perilymph with the opposite concentrations of sodium and potassium. The levels of sodium and potassium need to be tightly regulated in these compartments at all times in order for the vestibular system to function correctly.

In Meniere’s Disease, the ability to regulate these ionic concentrations fails. This causes the endolymphatic compartment to swell. It creates the sensation of pressure within the ear. The increased fluid pressure changes the function of the vestibular receptor, such that the input the brain receives from the vestibular system when turning the head does not match the input from the eyes or the rest of the body. A sensory mismatch is the essence of all forms of vertigo, however with time the brain will learn to adapt these reflexes and stabilize the vertigo.

Unfortunately, in Meniere’s disease, when the inner ear loses the ability to properly pump sodium and potassium in and out, the function of the inner ear can change with something as simple as dietary salt intake. This makes it very challenging for the brain to adapt the mismatched reflex, as it is essentially chasing a moving target.

As fluid pressure rises, the sensation of ear pressure can become painful, the tinnitus can increase, and people become progressively less stable. This endolymph can move into other areas of the inner ear, like the saccule and utricle, and disrupt their function as well (5). This may ultimately result in a Hydrops Crisis, where the pressure becomes so great that the membrane ruptures, sodium and potassium rapidly rush between compartments, and people report feeling like they are being slammed to the floor. Vertigo and nausea are severe during these episodes until the membrane stabilizes and proper salt concentrations can be restored.

The malabsorption of fluid can be a result of genetic variation, disruption of endolymphatic drainage systems, a mechanical obstruction, or altered bone anatomy. One study implied that endolymphatic hydrops can be secondary to past ear trauma (6).

What are the Consequences of Meniere’s Disease?

The unpredictable episodes of vertigo and the prospect of permanent hearing loss can be the most challenging aspects of Meniere's disease. The disease can unexpectedly create significant stress and anxiety. Vertigo can cause you to lose balance, increasing your risk of falls and accidents, and predispose you toward other neurological problems such as concussions and traumatic brain injuries.

Between attacks, it is common to experience frustrating symptoms including anxiety and fear, concentration difficulties and brain fog, clumsiness, fatigue and malaise, headache, light-headedness and unsteadiness, light and sound sensitivity, visual difficulties, and a host of other related problems.

How is Meniere’s Disease Usually Treated?

Meniere’s disease treatment typically involves the use of diuretic medications. These cause the kidneys to excrete sodium and potassium, which serves to decrease the fluid pressure in the inner ear. While these can be helpful, they also function to decrease blood pressure, and may create side effects of dizziness and light-headedness. They are usually coupled with a low-sodium diet to limit the opportunity for fluid pressure to accumulate. Vestibular rehabilitation therapy can be helpful in some cases. When symptoms are severe, Gentamycin injections or surgery can be employed to destroy the vestibular receptor itself, in the hope that over time the patient will learn to adapt to using only the unaffected ear (16).

How is the NeuroRescue Program different?

Meniere’s disease is usually treated as purely an inner ear disorder. While that may be where Meniere’s disease starts, as it progresses the brain attempts to adapt to the unstable inner ear signals. Over time these brain compensations can create more problems than they solve, leading to difficulty with visual pathways and eye movements, problems with balance and motor control, and cognitive and emotional challenges that are secondary but independent from the inner ear problem. These issues can progress to be the most troubling aspects of the disorder, and deserve as much therapeutic attention as the inner ear itself. By addressing all aspects of the condition, the NeuroRescue program gives us the best opportunity to not only limit the frequency and intensity of your flares, but also minimize your symptoms between attacks.

We use a wide variety of therapies for treating Meniere’s disease. These may involve various types dietary therapies to stabilize vestibular receptor function (7), or specific exercises to retrain the integration of your eyes and inner ear during head movement (8). It may involve specific forms of eye exercises to enhance your stability (9), or transcutaneous electrical stimulation to stimulate your vestibular system (10). It may involve specific types of visual stimulation exercises (11), or visual stimulation coupled with specific head movements (12). It may involve the use of transcranial magnetic stimulation to decrease your dizziness (13), or even the use of exercises performed in a virtual reality environment (14). All of our therapies are tailored to the specific realities of your case as determined by your unique diagnostic findings. No two NeuroRescue Programs are alike.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your Meniere’s Disease. In all of our cases of assumed Meniere’s, we begin by making certain that there are no central nervous system factors contributing to your symptoms. We do this by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your nervous system are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your central and peripheral nervous systems. It works to improve energy, endurance, and functional capacity within your involved fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.