Meniere’s Support Group (Tasmania) Inc
Formerly Meniere’s Australia
PO Box 202
MOONAH TAS 7009
Ph/Fax: (03) 6234 1494
Email: menieres.aus@tassie.net.au
What is Meniere’s Disease?
Meniere’s Disease or Meniere’s Syndrome is primarily a disorder of the inner ear and is characterised by hearing loss, tinnitus and episodic vertigo. A blocked up feeling in the affected ear is also a common symptom.
The pathological process behind Meniere’s Disease is often referred to as Endolymphatic Hydrops, and this term is used synonymously with Meniere’s Disease. Endolymphatic Hydrops is basically describes a swelling of a fluid called endolymph located in the inner ear. This fluid is surrounded by another sort of fluid called the perilymph which becomes compressed by the endolymph. This swelling is associated with the damage to the hearing and balance organs located in the inner ear found in Meniere’s Disease.
Although not a life threatening disease, in its worst form, Meniere’s Disease can be a major disability for the patient, and can have serious associated emotional and psychological effects. In it’s mildest form, the disease can be viewed as a manageable inconvenience to the individual.
What are the Symptoms of Meniere’s Disease?
Generally speaking, there are hearing (auditory) and balance (vestibular) symptoms associated with Meniere’s Disease. The vestibular and auditory symptoms may begin at the same time, one may begin earlier in the disease or one may dominate. Not all Meniere’s patients have the same symptoms, and the intensity of each symptom can vary greatly between individuals.
Although Meniere’s Disease is usually diagnosed as unilateral, over time (sometimes over a period of 20 years or more) it is estimated that in over 40% of patients both ears eventually become affected.
The 4 main symptoms are as follows:
1. Vertigo
The vertigo of Meniere’s Disease is episodic and patients typically suffer repeated attacks which can have little warning. The attacks are usually severe, violent and can be incapacitating. In the early stages of the disease, they can be associated with nausea and vomiting or blurred vision.
The attacks can occur at any time or place and can even wake the person from their sleep. They come on relatively suddenly within a few minutes, and can last from 10 minutes to several hours. Loss of consciousness is not a symptom of a Meniere’s attack, although the patient may experience feelings of faintness. After the attack, unsteadiness may persist for hours or days.
The sensation of vertigo can vary from the illusion of movement of oneself or one’s surroundings, to a sudden episode of loss of balance without any illusion of movement.
Hearing loss, tinnitus and a feeling of pressure in the ear are often associated with the attacks of vertigo, and changes in the quality of any of these symptoms may provide a warning to the patient.
In the later stages of the disease, the violent attacks of vertigo usually lessen and eventually cease, although the patient may complain of constant imbalance and unsteadiness, which is worse in the dark.
2. Tinnitus
In Meniere’s Disease, tinnitus is the subjective sensation of noises in one or both ears. The sound can be described as a whistling, hissing, roaring or buzzing sound. The word tinnitus is derived from the Latin word “tinnere” which means to ring. Although tinnitus in its severe form affects only about 2% of the population, it is estimated that up to 90% of people have some degree of tinnitus.
In early stages the tinnitus tends to be low pitched, especially before and during an attack of vertigo, and in later stages can progress to a high pitched tone and become a continuous noise. It is usually not related to the timing of ones pulse or heartbeat.
The tinnitus can increase in severity as Meniere’s Disease progresses, particularly as the level of hearing loss increases.
Tinnitus is a symptom that is experienced only by the patient, and there are no external signs of the illness. Because of this, the ordeals that the patient may go through are often unappreciated by others. Often the patient receives little sympathy or support, and at worst may be told something along the lines of “just get over whatever it is.”
Because of the very irritating nature of tinnitus there can be strong associated psychological effects, manifesting as stress, anxiety or other emotional responses.
3. Hearing Loss
In the earlier stages, the hearing loss associated with Meniere’s Disease is typically in the lower frequencies, is unilateral and may fluctuate between attacks. The level of hearing loss is not related to the severity of the vertigo attack.
In the later stages of Meniere’s Disease, the hearing loss increases, becoming permanent and no longer fluctuating. Both ears tend to become affected at this later stage with both high and low frequencies being affected.
The hearing loss is of the sensorineural type (”nerve deafness”) and is due to damage to the cochlear hair cells of the inner ear which normally transmit sound via the hearing nerve to the hearing centre in the brain.
As well as a loss of volume and clarity caused by the hearing loss, Hyperacusis and Recruitment are two other symptoms associated with Meniere’s Disease hearing loss.
Hyperacusis is an abnormal increase in the patient’s sensitivity to sound of relatively normal volume. This does not mean that the patient has exceptional hearing, and is in fact associated with hearing loss. Normal everyday sounds can become unbearably loud possibly causing pain and much distress. Some patients may have an increased sensitivity to sounds of a certain frequency.
Recruitment, on the other hand, is an unequal increase in the response of the ear to sound whose intensity is being increased in equal steps. This can mean that a small increase in volume can be perceived by the patient as a much larger increase in volume. Recruitment is a common finding in Meniere’s patients and may result from damage to the inner ear.
Diplacusis is another symptom which may be present in Meniere’s Disease, where the pitch of sound may be altered in the affected ear by 1/3 to ½ a note. Patients may think that they are hearing two different sounds.
4. Aural Fullness
This is a feeling of increased fullness or pressure in the affected ear, and may herald an attack of vertigo. One patient described it as follows:
“My ear feels so blocked I want to shove a knitting needle through it”
Other patients may describe the feeling as like having cotton wool stuffed in their ears. The feeling of fullness is caused by fluid in the inner ear cavity which has swelled up increasing the pressure in the inner ear (endolymphatic hydrops).
Other Symptoms:
There are many other symptoms that can be found in Meniere’s patients. Some of these symptoms which are directly related to the underlying pathological changes associated with the disease process include:
* visual disturbances including nystagmus (jerking of the eyes), photosensitivity (sensitivity to bright light) and difficulty focusing and watching moving objects. Visual disturbances may precipitate dizziness and nausea
* muscle stiffness or ache, especially after an attack
* headaches or light headedness
* fatigue
* clumsiness
Other symptoms like stress, anxiety and depression can result from the effect the disease has on the patient’s normal way of life. These psychological symptoms can be as important as the physical manifestations of the disease. Some of these symptoms include:
* anxiety and worry
* fear
* depression
* loss of self confidence, self esteem and independence
* loss of appetite
* poor memory
* anger or rage
