Ménière’s disease

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What is it about ?

The human ear has two functions: hearing and balance.

Hearing is provided by the outer ear (the pinna and the auditory canal), the middle ear (the eardrum and the ossicles) and the inner ear (the cochlea and the auditory nerve).

Balance is regulated by a balance organ (the posterior labyrinth or vestibule) located in the inner ear. The labyrinth is filled with a thick liquid (endolymph). The system works like a kind of bubble level. As soon as we change our posture, the endolymph moves and sends information about the position of our body to our brain (via the vestibular nerve). We always know in what position our body is and our balance is maintained. Sometimes the system operates with a delay. Our brains cannot keep up with changes in posture fast enough. This is what causes, for example, motion sickness or the feeling of nausea on a swing.

Ménière’s disease is caused by an excess of endolymph. As a result, the pressure in the inner ear increases and our sense of balance is disturbed. Ménière’s disease presents as attacks of vertigo.

The cause is unknown. Caffeine, tobacco, alcohol, salt and taurine could have a negative influence on this phenomenon. There is no consensus on the role that stress plays. People who are stressed are more likely to have bouts of vertigo from Ménière’s disease, but that’s not to say that it is stress that causes these bouts of vertigo.

In addition, a feeling of spinning caused by other factors is often referred to as Ménière’s disease, while the cause is not related to an increase in the amount of endolymph and is not therefore not from Ménière’s disease. Those responsible for these sensations can thus be anatomical abnormalities of the ear, hereditary disorders, diseases of the immune system such as allergies, viral infections, circulatory disorders such as hemorrhage or embolism, lesions subsequent to an accident and tumors in the inner ear.

In whom and how often does it occur?

Ménière’s disease is a rare disease which, in Europe, affects between 50 and 200 people out of 100,000. On a Belgian scale, this represents between 5,000 and 20,000 patients affected by the disease. The disease mainly occurs between the ages of 20 and 60.

How to recognize it?

Ménière’s disease presents as attacks of spinning (vertigo), ringing in the ears and hearing loss.

Spinning, as the name suggests, is characterized by the sensation that the room is spinning.
Hearing complaints are usually limited to one side. Often times, you feel pressure in your ear just before the onset of a seizure. Sometimes the noises are distorted and you hear a reverberating sound. After the seizure, hearing usually returns to normal gradually, but not always.

A typical seizure can be associated with nausea and vomiting and lasts between 20 minutes and 12 hours. The level of consciousness remains normal during the crisis. You have no symptoms of paralysis.
In some cases (15-50%), hearing loss appears later on both sides.

How is the diagnosis made?

The doctor makes the diagnosis of Ménière on the presence, at the same time, of the 3 main symptoms: ringing in the ears, recurrent spinning and hearing loss.

He will also ask you to follow his finger with your gaze, without turning your head, as he moves it in all directions. If you have Ménière’s disease, the eyeball moves quickly, jerkily, in a specific direction when you look inward, outward, up, or down. This phenomenon is known as nystagmus.

In addition, the doctor will perform a basic neurological examination.

Often, the diagnosis is made only after several attacks. A consultation with the ENT (otolaryngologist) is necessary for additional examinations, including a hearing test and a balance test.

What can you do ?

Do your best to avoid stress and adopt a regular lifestyle, this is as important as taking medication. Limit your salt intake. Also avoid movements or postures that trigger the seizures, such as sudden head rotations.

Do not engage in activities that may be dangerous; For example, avoid working on a ladder or at height.

If you have frequent seizures, the specialist can give you an exercise program to do at home. By repeating exercises that normally trigger the symptoms, you can somehow get used to them, so that the symptoms either go away or are less severe.

What can your doctor do?

The role of drugs in the management of Ménière’s disease is very limited. Drug treatment (betahistine or diuretic) may possibly be tried.

Most often, we start with a high dose of betahistine, until symptoms disappear. Then, the dosage is gradually reduced until the minimum dose is reached without recurrence of symptoms, and it is maintained for 3 months.

Betahistine potentially has a positive effect on spinning and ringing in the ears, but not on hearing loss. However, it has not yet been proven to be more effective than a placebo in preventing seizures.

A low dose diuretic is only suitable if you do not have low blood pressure. The medicine is said to decrease the amount of fluid in the inner ear.

In the face of an acute attack, medication for vomiting is also prescribed in the form of suppositories.

Can you drive if you have Ménière’s disease?

In Belgium, being able to drive is determined by a Royal Decree on driving licenses. Annex 6 defines the minimum standards and certificates of physical and mental fitness for driving a motor vehicle. Section 8 of this appendix deals with hearing and vestibular disorders and says that a person with sudden attacks of dizziness or balance disorders is not fit to drive. This person must request a driving aptitude certificate from the ENT doctor of their choice. A written specialist’s report is required for professional drivers. It is therefore the ENT doctor who determines if and for how long you cannot drive. You are responsible for informing the traffic police, when you apply for a driving license, as well as your insurer, of the specifics related to your state of health.

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