Menieres disease is a disorder of fluid balance within the inner ear where there is too much endolymphatic fluid present.
The usual onset of symptoms is between 40 to 65 years of age and it affects up to 1% of the population. Prior to 1970 Menieres was often incorrectly given as a diagnosis as much less was known about other vestibular disorders.
Pathophysiology is unclear however there is thought to be a genetic link.
There may be either overproduction or malabsorption of endolymph for various reasons including altered function of the endolymphatic duct or altered anatomy or anatomical variations within the inner ear. Eventually this leads to hair cell loss and damage.
Triggers include stress and diet high in salt.
In early stages there is more likely to be hearing loss and symptoms affecting only one ear but 30% to 50% of people will go on to have both ears affected within 10 years of diagnosis. The hearing loss generally worsens with each attack.
Symptoms include spontaneous vertigo lasting between 20 minutes and 24 hours. There will usually be tinnitus or ‘fullness’ in one ear and fluctuant changes in hearing. There will be permanent progressive hearing loss over time. There may also be postural imbalance, nausea or vomiting.
Often there is an ‘aura’ preceding an attack and attacks may appear in clusters.
Vestibular migraine presents with similar symptoms and your therapist will need to do a thorough history, examination and potentially refer you for other tests to differentiate between these diagnoses.
Testing may include Vestibular Function testing (VFTs), Vestibular Evoked Myogenic Potential (VEMPs), Vestibulocochleogram (ECoG) and Audiometry conducted at a baseline level and repeated while you are episodic.
Treatment during an acute attack may include bed rest and vestibular sedatives. There are various medical interventions as well as dietary and lifestyle changes that may be suggested to help to prevent further attacks.
If vestibular symptoms prevail between attacks vestibular therapy may help.
In the later stages surgery is an option and one 10% of cases will progress to some type of surgery. However this is only indicated if symptoms become very disabling
Book now with our Vestibular Physiotherapist, Alison Underwood!