Demystifying Dizziness- Ménière’s Disease (The roughest inner ear disease)
Described as one of the roughest inner ear conditions, Ménière’s disease is not something to be taken lightly. Though not a relatively common condition, for those who have it, Ménière’s disease can hit like a storm and turn life upside down.
Ménière’s disease is named after Dr. Prosper Ménière, a 19th century French physician who was the first to suggest a connection between balance problems and the inner ear. It had long been accepted that the inner ear functioned for hearing; however, at that time there was little evidence to support a dual function in balance and equilibrium. Near the end of his life, Dr. Ménière wrote a paper describing several of his patients who suffered from multiple symptoms, the three most common of which included vertigo, one sided hearing loss, and tinnitus. It wasn’t until years later, as scientific investigation methods advanced, that doctors were able to properly dissect the inner ear and discover organs for both hearing and balance. This condition that Dr. Ménière helped identify over 100 years ago now bears his name- Ménière’s disease.
Causes of Meniere’s Disease
Ménière’s disease is thought to be caused by a build-up of fluid or pressure in the endolymphatic sac of the inner ear, which contains fluid (endolymph) that surrounds the hearing and balance structures. Build-up of endolymphatic fluid can result in the development of something called endolymphatic hydrops, often just referred to as hydrops. What causes this fluid build-up is still under investigation, though some groups are looking at the association between Ménière’s disease and migraine disorders, as there appears be a greater prevalence of people suffering from migraine disorders in conjunction with Ménière’s disease than the general population.
In addition, head or neck trauma can exacerbate the symptoms of Ménière’s disease. In particular injury to the upper neck can affect blood and cerebral spinal fluid flow to and from the head. This can result in pressure changes in the head that may be a factor in triggering a Ménière’s attack. Several case studies have documented improvement of Ménière’s symptoms, particularly the symptom of vertigo, following specific treatment of an upper neck injury.
So, what are the common symptoms of Ménière’s Disease?
A person with Ménière’s disease may experience a host of different symptoms, though the diagnosis is made by the presence of a classic triad of symptoms. These are:
· Rotatory vertigo (true spinning sensation)
· Episodic hearing loss
· Roaring tinnitus
In about 80% of cases, these symptoms will only effect one ear. The hearing loss typically begins with the lower frequencies, which can gradually progress to full deafness between episodes. In addition to this classic triad, many people will also describe a sensation of fullness in the affected ear.
What can you do about it?
At this time, there is unfortunately no one cure for Ménière’s disease. Hearing and balance testing may be ordered to assess the functional deficits in these areas and hearing aids and vestibular training may be prescribed. An MRI or CT scan may also be ordered to rule out other pathologies.
Common management strategies include medications to reduce fluid build-up in the inner ear, surgery to cut the vestibular nerve, and lifestyle modifications, including dietary restrictions. High sodium intake has been associated with triggering attacks. Restricting intake of sodium, caffeine, alcohol, and chocolate may help in reducing Ménière’s attacks.
Finally, vestibular therapy may help to reduce some of the vestibular compensation that occurs due to the vertigo attacks and treatment of any upper neck injury can help to optimize proper fluid flow and pressure build-up in the head.
Dr. Speranza is an upper cervical Chiropractor in Calgary, Alberta, Canada. She follows the protocols of the National Upper Cervical Chiropractic Association (NUCCA) to help people experiencing problems with postural related dizziness regain balance, return to doing the activities that they love, and ultimately take back control of their health.