Ménière's disease

How to recognise it

Ménière's disease is caused by an excess of fluid in the inner ear. It presents with a very characteristic clinical picture, involving attacks that combine:

• Vertigo lasting hours —not seconds—, accompanied by nausea and vomiting.
• Fluctuating hearing loss, usually in one ear only, which worsens during attacks.
• Tinnitus and a sensation of a blocked ear or pressure, which often warn that an attack is about to start.

Between attacks, there may be long periods without symptoms, which leads many people to delay seeking medical advice.

Diagnosis

Diagnosis is clinical, supported by audiometry —which documents the hearing loss and its pattern— and vestibular tests. It is completed with the necessary tests to rule out other causes of vertigo associated with hearing loss. It is important to bear in mind that there are other, more common causes of recurrent vertigo attacks, which is why making an accurate differential diagnosis is so important.

An audiometry performed during or shortly after an attack is particularly useful, so it is advisable to consult a specialist as soon as possible after an episode.

Treatment

Treatment addresses two fronts. During an acute attack: rest and medication for vertigo and nausea, for as short a time as possible. In the long term: reducing dietary salt, controlling caffeine, alcohol and tobacco, looking after sleep and managing stress —recognised triggers—, alongside the maintenance medical treatment prescribed by the specialist. In uncontrolled cases, additional treatments exist, sometimes intratympanic, which are assessed on an individual basis.

Living with it

It is a chronic and unpredictable condition, but most people achieve good control with appropriate follow-up. Between attacks, when indicated, vestibular rehabilitation helps restore confidence when moving, and monitoring hearing allows hearing solutions to be considered if the loss progresses.