Ménière’s Disease: A Struggle with Hearing and Balance

The Fragile Symphony: 10 Conditions That Can Wreak Havoc on Your Hearing and Balance Part 1

This article is written for general understanding only and is not based on personal experience or medical expertise.

Santie looks nervously at her music teacher, staring through the window and then at the music sheets on the piano. She feels the anxious thumping of her heart in her chest while wiping her clammy hands on her jeans before placing them in position on the piano’s keys.

The simple sound of Beethoven’s Ode To Joy fills the room, dancing in the air in perfect harmony. Santie slowly starts to relax, enjoying the rhythm of her fingers, until suddenly – she misjudged and hit the wrong key!

The note reverberated in the air, slipping away from the other notes, rushing towards the music teacher’s ear. Santie freezes, anxiously waiting for her music teacher’s reaction.

The sound waves of the little wayward note enter the music teacher’s outer ear and travel through the ear canal to the vibrating eardrum. The vibrations rush through the middle ear until it reaches three tiny bones in the ear: the malleus (hammer), incus (anvil), and the stapes (stirrup). These bones amplify and strengthen the vibrations to reach the cochlea in the inner ear.

The little wayward note enters the cochlea and feels himself tumbling in its fluid waves. Finally, the little note feels himself changing as the sensitive inner cells convert the vibrations to sound waves. These newly formed sound waves travel from the inner ear cells through the auditory nerve until they finally reach the brain. When the brain registers and interprets this discordant note, the teacher spins around, a puzzled expression on his face…

Hearing can be compared to a beautiful symphony, with all the parts of our ears working in harmony. However, just as a wrong note can create discordance, various illnesses and disorders can affect and damage the harmonious working of our ears.

These disorders can lead to hearing loss, vertigo, tinnitus, and balance issues. They create challenges in communication, making conversations exhausting, leading to fatigue, and complicating daily activities, ultimately affecting one’s quality of life.

In this series, The Fragile Symphony: How 10 Conditions Can Wreak Havoc on Your Hearing and Balance, we will explore ten conditions, their symptoms, challenges, and the available treatment options that can restore harmony to your hearing system.

Let’s start by understanding the rare chronic disorder Ménière’s Disease and its significant impact on balance and hearing.

1 What Is Ménière’s Disease?

According to recent data from the National Institute on Deafness and Other Communication Disorders, Ménière’s disease is rare, with 615,000 occurrences out of a total of 330 million people in the United States. It is a chronic condition that affects your hearing and sense of balance.

It has a sudden onset, and symptoms come and go, creating havoc on your daily activities. Untreated, symptoms will worsen over time, resulting in permanent hearing loss and ongoing balance issues.

Now that we understand Ménière’s disease, let’s explore its causes.

2 What Causes Ménière’s Disease?

Experts believe a buildup of endolymph is a possible cause. It is a clear fluid in the labyrinth located in the inner ear. Its function is to convey sound, balance, and position information to the central sensory neural structures. Excess endolymph disrupts hearing and balance signals sent to the brain. Allergies, infections, head injuries, migraines, and blockages in the inner ear are possible causes of endolymph buildup.

With an understanding of the disease, let’s explore the possible symptoms of Ménière’s disease.

3 What Are The Symptoms?

The symptoms start during episodes lasting between 20 minutes to 24 hours. Occurences can fluctuate between back-to-back episodes or with extended periods in between.

The most significant symptoms are:

• Vertigo:It makes you feel like the world is spinning, even standing still. Because the disorder occurs without warning, it can result in unexpected falls.
• Hearing Issues:It causes hearing issues, usually only in one ear. It starts with difficulty hearing lower pitches. Without treatment, it can cause permanent hearing loss.
• Tinnitus:It is an internal ringing or buzzing sound in the ear that only you hear. In the case of Ménière’s disease, it can sound like whirring or wooshing sounds. A significant trait of tinnitus is that nobody else hears these sounds.
• Other symptoms:Feeling pressure in the affected ear, nausea, and vomiting.

In addition to the symptoms, you also need to know the risk factors and possible complications to ensure you get the best possible treatment and care.

4 Risk Factors and Complications

• Women are more likely to develop this disorder than men – usually between the ages of 40 and 60. In seven to ten per cent of cases, it has a genetic cause with previous occurrences in the family history. Particular autoimmune diseases – where your immune system attacks your body – can increase the risk for Ménière’s disease.
• Rheumatoid arthritis affects the tissue linings of your joints.
• Ankylosing Spondylitis (SA) attacks the joints in the spine.
• Lupus damages organs and tissues throughout your body.

Besides serious falls and hearing difficulties, people with Ménière’s disease can also develop mental health conditions, such as anxiety and depression.

If any symptoms or risk factors apply to you, what doctor do you need to see, and how will they diagnose Ménière’s disease?

5 Ménière’s Disease Diagnosis

An otolaryngologist (ENT) diagnoses the disease through physical and neurological exams. However, they would also ask you about occurrences of vertigo and hearing loss and their severity and duration.

They will also do tests to rule out other possible causes of your symptoms, like

• A hearing test to exclude hearing loss.
• A test to check the reflexes of your inner ear, balance system, and eye muscles.
• An MRI scan to rule out potential brain tumours or other issues.

With this in mind, what treatment options are available for you to lead an optimal life and reduce attack frequency?

6 What Are The Treatment Options?

Ménière’s disease is incurable, and treatments only help to reduce the severity and duration of your attacks. Possible treatment options are lifestyle changes, medication, therapy, assistive devices, and surgery as a last resort.

• Lifestyle changes:It includes following a low-salt diet, reducing caffeine and alcohol intake, and managing stress.
• Medicines:The most common medications to treat symptoms are diuretics, betahistine (to regulate the fluid in your body), motion sickness, and anti-nausea tablets.
• Injections:Alternatively, you may need injections of intratympanic steroids through the eardrum or the antibiotic Gentamicin (with the risk of further hearing loss.)
• Vestibular rehabilitation:
• It involves exercises to improve your balance and manage vertigo symptoms.
• Devices:The use of hearing aids and cochlear implants to treat hearing loss.
• Pressure Pulse Treatment:A device is used to ‘puff’ air pressure pulses into the middle ear to regulate endolymph levels.
• Cognitive Behavioural Therapy (CBT):It can help you cope with stress, anxiety, and depression.
• Surgery:There are various surgical procedures to relieve the pressure from the inner ear.
  • During the endolymphatic sac procedure, the surgeon cuts through the endolymphic sac to drain excess fluid. Sometimes, they will insert a small stent for continued draining.
  • A vestibular nerve section entails cutting the nerves that send balance signals to your brain to prevent vertigo attacks without damaging your hearing. It is a delicate operation since hearing and balance share the same nerve.
  • During a labyrinthectomy, the surgeon removes the labyrinth in the inner ear, which controls balance. Because it causes hearing loss in the affected ear, it is only done once you have lost all hearing in the affected ear.

Considering the complexities of this disease, let’s look at ways to reduce the overall risk and outlook.

7 Prevention And Outlook

You can’t prevent Ménière’s disease. However, you can reduce your risk of it worsening through early treatment. This chronic disease comes and goes, and you must manage the symptoms with the medicines your medical practitioner prescribes.

Naturally, even though it is incurable, there are practical steps you can take to live optimally with Ménière’s disease.

Living with Ménière’s Disease

Since Ménière’s disease is incurable, taking care of yourself is critical. Following four simple steps will ensure you can still live a quality life, even with Ménière’s disease.

1. Ensure you always have your medicine on hand to take them immediately when an episode starts.
2. Start a diary and note any possible triggers that cause an attack. It can be anything from allergies, excess salt, tiredness, or overstimulating environments. Avoiding these triggers can help you prevent future attacks.
3. Monitor your diet and ensure you limit trigger substances like caffeine and alcohol. You must check the food labels for all pre-packaged and tinned foods.
4. Get enough rest to prevent attacks and give yourself enough time to recover in a quiet and calm environment after an attack.

Any disease affecting our intricate hearing system is scary, and you will need time to adjust. However, humans adapt in extraordinary ways, enabling them to lead a quality life regardless. Knowledge is power. Follow the four steps above and ensure one discordant note doesn’t spoil your symphony!

Have you or someone you know experienced challenges with hearing or balance? How did it impact daily life, and what helped most in managing it?

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Curious about the Epley Maneuver?
While it’s not typically used to treat Ménière’s Disease directly, it’s a well-known technique for Benign Paroxysmal Positional Vertigo (BPPV)—another common cause of sudden vertigo.
You can read more about how it works and when it helps in my article:
How the Epley Maneuver can Help with Vertigo