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Ménière’s Disease

Also indexed as: Idopathic Endolymphatic Hydrops, Ménière’s Syndrome

Illustration

Ringing or roaring sounds in the ears, along with episodes of vertigo, may signal the presence of Ménière’s disease. According to research or other evidence, the following self-care steps may ease many of the symptoms:

What you need to know

  • Fight back with flavonoids
  • Take 2 grams a day of hydroxyethylrutosides or similar flavonoids to improve symptoms
  • Skip the salt
  • Follow a low-salt diet to help reduce or stabilize symptoms
  • Kick the habits
  • Avoid alcohol, nicotine, and caffeine to decrease the frequency of MD attacks
  • Uncover allergies
  • Work with a knowledgeable healthcare provider to see if detecting and treating allergies to airborne or food allergens might improve your symptoms
  • See a specialist
  • Consult with an expert familiar with vestibular rehabilitation exercise, an approach that may help prevent vertigo

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full Ménière’s disease article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About Ménière’s disease

Ménière’s disease (MD) is a disorder of the inner ear causing episodes of dizziness (vertigo); ringing, buzzing, roaring, whistling, or hissing sounds in the ears (tinnitus); fluctuating levels of hearing loss; and a sensation of fullness in the ear.

Head trauma and syphilis can cause MD, although in most cases the cause is unknown.

Product ratings for Ménière’s disease

Science Ratings Nutritional Supplements Herbs
2Stars

Flavonoids (hydroxyethylrutosides)

  
1Star  

Ginkgo
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with Ménière’s disease may have vertigo that may be associated with nausea and vomiting. Symptoms may also include a recurrent feeling of fullness or pressure in the affected ear and hearing difficulty. People with Ménière’s disease may also have tinnitus, which may be intermittent or continuous. The symptoms of MD are associated with an underlying condition referred to as endolymphatic hydrops, an excess accumulation of the fluid of the inner ear.1 When people have only one of the symptoms associated with Ménière’s disease, such as tinnitus or vertigo, the condition is not usually considered MD.

Medical options

Over-the-counter antihistamines, such as dimenhydrinate (Dramamine) or meclizine (Dramamine Less Drowsy Formula) might help treat dizziness.

Prescription anticholinergic drugs, such as scopolamine (Transderm-Scop), prochlorperazine (Compazine), and trimethobenzamide (Tigan), and meclizine (Antivert), as well as sedatives such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax), are often used to treat symptoms associated with Ménière’s.

People frequently affected by disabling vertigo might require a surgical treatment (vestibular neurectomy or labyrinthectomy). Some people might benefit from a tinnitus masker, which is a hearing device that produces a sound that is more tolerable than the ringing in the ears. Healthcare providers may also suggest the use of earplugs in the presence of loud noises to prevent damage to the ear.

Dietary changes that may be helpful

A low-salt diet (no more than 800–1,000 mg sodium per day) combined with diuretic medication, is believed to reduce endolymphatic hydrops,2 and is often recommended in MD.3 4 5 While the benefits of a low salt diet and diuretics have not been scientifically proven for this condition,6 clinics specializing in MD report a significant reduction or stabilization of symptoms with this regimen.7 Preliminary human trials suggest a low-salt diet may reduce the progression of hearing loss associated with MD.8

MD is associated with allergies to airborne particles, mold, and food in some individuals, according to many preliminary reports.9 10 11 12 13 In one preliminary study, 50% of participants with MD reported known food or inhalant allergies.14 In a controlled study, participants with MD who underwent allergy treatment, including avoiding foods suspected of provoking allergic reactions, reported statistically significant improvement in tinnitus, vertigo, and hearing.15 In this study, the most common food allergies were to wheat and soy. Most participants also had allergies to milk, corn, egg, and yeast.

Some cases of MD are associated with high blood triglycerides and cholesterol, and abnormalities in blood sugar regulation, such as diabetes and hypoglycemia.16 17 18 19 20 In one preliminary study,21 a modified hypoglycemia diet with moderate to high intake of protein, moderate to low intake of fat, and restricted intake of complex carbohydrates was found to reduce MD symptoms in a large number of patients with blood sugar abnormalities. Participants with high cholesterol were put on low cholesterol diets, and those that were overweight were put on calorie-restricted diets. In addition, refined carbohydrates, alcohol, and caffeine were prohibited, and small frequent meals with between meal snacks were recommended. A majority of participants were also given supplements of calcium, fluoride, and vitamin D as described below, so the importance of these dietary changes to the overall effectiveness of the program cannot be determined. This intriguing report needs confirmation from controlled trials.

Lifestyle changes that may be helpful

Lifestyle changes often recommended for MD include the elimination of caffeine, nicotine, and alcohol.22 Although not scientifically proven, intake of these substances is believed to increase the frequency of MD attacks. In animal studies, both alcohol and caffeine have been reported to impair mechanisms in the inner ear that assist in maintaining balance.23

Vitamins that may be helpful

Certain flavonoids, known as hydroxyethylrutosides (HR), have been reported to improve symptoms of MD in one double-blind study. In this study, 2 grams per day of HR for three months resulted in either stabilization of or improvement in hearing.24 Other types of flavonoids have not been studied as treatments for MD.

Some cases of MD are associated with otosclerosis,25 26 27 28 a disease affecting the small bones of the inner ear. Otosclerosis often goes undiagnosed in people with MD, although the coexistence is well documented.29 While preliminary reports suggest otosclerosis may be a cause of MD,30 31 the relationship between these two conditions remains unclear. Sodium fluoride, a mineral compound available only by prescription, is reported to improve otosclerosis.32 33 34 35 In a preliminary study,36 people with MD and otosclerosis were given supplements of 50 mg of sodium fluoride, 200 mg calcium carbonate, and a multiple vitamin supplying 400–800 IU of vitamin D per day, for periods ranging from six months to over five years. Many participants also had blood sugar abnormalities, and were asked to follow a modified hypoglycemia diet as described above. Significant improvement in vertigo was reported within six months, but improvements in hearing required one to two years. Because most participants used both diet and supplements, the importance of fluoride, calcium, and/or vitamin D to the overall results of this trial is unclear.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

: Although Ginkgo biloba extract (GBE) has not been studied specifically for its effects in MD, in preliminary studies it has been reported to reduce symptoms of tinnitus, vertigo, and hearing loss due to unspecified inner ear disorders.37 Controlled research using GBE is needed to determine whether it is a treatment option specifically for MD.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

People with MD are frequently found to have musculoskeletal disorders of the head and neck,38 including cervical spine disorders (CSD; disorders of the joints of the neck),39 and disorders of the jaw (craniomandibular disorders or CMD).40 Physical therapy to the cervical spine relieves MD-like symptoms in some cases, according to one preliminary report.41 Although spinal manipulation has been shown to reduce vertigo in preliminary human studies,42 43 44 controlled research with MD patients is lacking.

Some authorities recommend psychological counseling45 to reduce both the significant emotional distress caused by living with this disorder46 47 and possible stress-related MD symptoms,48 49 however, the benefits of counseling have not been established by controlled research. MD is not caused by psychological factors,50 and it is unclear whether stress increases the frequency or severity of attacks.51 Preliminary human studies suggest that stress increases awareness of symptoms,52 particularly vertigo.53 In a controlled human study of tinnitus, which included three participants with MD, weekly one-hour sessions of relaxation and coping techniques for ten weeks significantly reduced both tinnitus and tinnitus annoyance.54 Since very few of these participants had MD, it is not clear whether these techniques would be helpful for people with MD.

Vestibular rehabilitation exercises, used primarily to aid in recovery from vertigo, are also recommended by some authorities for MD,55 although controlled research on these exercises for MD is lacking. According to these authorities, the exercises should be started only after symptoms have been stabilized with other treatments, and should not be done during active MD. A qualified musculoskeletal healthcare specialist should be consulted.

Transcutaneous electrical nerve stimulation (TENS), a form of physiotherapy used by musculoskeletal healthcare specialists, has been reported to reduce tinnitus in people with MD in preliminary studies.56 57 58 TENS is thought to improve tinnitus by increasing circulation to the inner ear.59 In one large preliminary trial, participants with tinnitus due to various causes, including MD, received two 25- to 30-minute treatments to the ear per week for three to five weeks.60 Sixty percent of people with MD reported significant improvement of tinnitus after this treatment, and many reported a decrease in pressure in the treated ear. A controlled trial comparing the effectiveness of TENS and applied relaxation (AR; the use of an audiotape to guide the participant through a series of muscle relaxation exercises) in MD found either treatment produced similar positive results,61 but these could have been due to placebo effects. In this study, participants treated themselves with three 30-minute TENS treatments to the hand per day for two weeks, with one participant continuing treatment for three months.

Acupuncture is reported to reduce symptoms of MD in preliminary studies.62 63 In one trial, vertigo was eliminated after one to three treatments in a group of 34 MD patients, and measurements of hearing also improved.64 Controlled research is needed to confirm these results.

References:

1. Baloh RW. Vertigo. Lancet 1998;352:1841–6 [review].

2. Knox GW, McPherson A. Meniere’s disease: differential diagnosis and treatment. Am Fam Physician 1997;55:1185–90, 1193–4 [review].

3. Pyykko I, Magnusson M, Schalen L, Enbom H. Pharmacological treatment of vertigo. Acta Laryngol 1988; 455:77–81 [review].

4. Saeed SR. Diagnosis and treatment of Meniere’s disease. BMJ 1998;316:368–72 [review].

5. Boles R, Rice DH, Hybels R, Work WP. Conservative management of Meniere’s disease: Furstenberg regimen revisited. Ann Otol Rhinol Laryngol 1975;84:513–7.

6. Stahle J. Medical treatment of fluctuant hearing loss in Meniere’s disease. Am J Otol 1984;5:529–33 [review].

7. Spencer JT Jr. Hyperlipoproteinemia, hyperinsulinism, and Meniere’s disease. South Med J 1981;74:1194–7,1200.

8. Saeed SR. Diagnosis and treatment of Meniere’s disease. BMJ 1998;316:368–72 [review].

9. Boles R, Rice DH, Hybels R, Work WP. Conservative management of Meniere’s disease: Furstenberg regimen revisited. Ann Otol Rhinol Laryngol 1975;84:513–7.

10. Santos PM, Hall RA, Snyder JM, et al. Diuretic and diet effect on Meniere’s disease evaluated by the 1985 Committee on Hearing and Equilibrium guidelines. Otolaryngol Head Neck Surg 1993;109:680–9.

11. Gibbs SR, Mabry RL, Roland PS, et al. Electrocochleographic changes after intranasal allergen challenge: A possible diagnostic tool in patients with Meniere’s disease. Otolaryngol Head Neck Surg 1999;121:283–4.

12. Derebery MJ. Allergic and immunologic aspects of Meniere’s disease. Otolaryngol Head Neck Surg 1996;114:360–5.

13. Derebery MJ. The role of allergy in Meniere’s disease. Otolaryngol Clin North Am 1997;30:1007–16 [review].

14. Dornhoffer JL, Arenberg IK. Immune mechanisms in Meniere’s syndrome. Otolaryngol Clin North Am 1997;30:1017–26 [review].

15. Howard BK, Mabry RL, Meyerhoff WL, Mabry CS. Use of a screening RAST in a large neuro-otologic practice. Otolaryngol Head Neck Surg 1997;117:653–9.

16. Derebery MJ, Rao VS, Siglock TJ, et al. Meniere’s disease: an immune-complex mediated illness? Laryngoscope 1991;101:225–9.

17. Derebery MJ. Allergic management of Meniere’s disease: an outcome study. Otolaryngol Head Neck Surg 2000;122:174–82.

18. Spencer JT Jr. Hyperlipoproteinemia, hyperinsulinism, and Meniere’s disease. South Med J 1981;74:1194–7, 1200.

19. Kirtane MV, Medikeri SB, Rao P. Blood levels of glucose and insulin in Meniere’s disease. Acta Otolaryngol Suppl 1984;406:42–5.

20. Mangabeira Albernaz PL, Fukuda Y. Glucose, insulin and inner ear pathology. Acta Otolaryngol 1984;97:496–501.

21. Brookler KH, Glenn MB. Meniere’s syndrome: an approach to therapy. Ear Nose Throat J 1995;74:534–8,540, 542.

22. Karjalainen S, Sarlund H, Vartiainen E, Pyorala K. Plasma insulin response to oral glucose load in Meniere’s disease. Am J Otolaryngol 1986;7:250–2.

23. Brookler KH, Glenn MB. Meniere’s syndrome: an approach to therapy. Ear Nose Throat J 1995;74:534–8, 540, 542.

24. Moser M, Ranacher G, Wilmot TJ, Golden GJ. A double-blind clinical trial of hydroxyethylrutosides in Meniere’s disease. J Laryngol Otol 1984;98:265–72.

25. Franklin DJ, Pollak A, Fisch U. Meniere’s symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct: an analysis of a causal relationship between otosclerosis and Meniere’s disease. Am J Otol 1990;11:135–40.

26. Liston SL, Paparella MM, Mancini F, Anderson JH. Otosclerosis and endolymphatic hydrops. Laryngoscope 1984;94:1003–7.

27. Freeman J. Otosclerosis and vestibular dysfunction. Laryngoscope 1980;90:1481–7.

28. Sismanis A, Hughes GB, Abedi E. Coexisting otosclerosis and Meniere’s disease: a diagnostic and therapeutic dilemma. Laryngoscope 1986;96:9–13.

29. Sismanis A, Hughes GB, Abedi E. Coexisting otosclerosis and Meniere’s disease: a diagnostic and therapeutic dilemma. Laryngoscope 1986;96:9–13.

30. Franklin DJ, Pollak A, Fisch U. Meniere’s symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct: an analysis of a causal relationship between otosclerosis and Meniere’s disease. Am J Otol1990;11:135–40.

31. Brookler KH, Glenn MB. Meniere’s syndrome: an approach to therapy. Ear Nose Throat J 1995;74:534–8, 540, 542.

32. Freeman J. Otosclerosis and vestibular dysfunction. Laryngoscope 1980;90:1481–7.

33. Bretlau P, Hansen HJ, Causse J, Causse JB. Otospongiosis: morphologic and microchemical investigation after NaF-treatment. Otolaryngol Head Neck Surg 1981;89:646–50.

34. Causse JR, Causse JB, Uriel J, et al. Sodium fluoride therapy. Am J Otol 1993;14:482–90 [review].

35. Sismanis A, Hughes GB, Abedi E. Coexisting otosclerosis and Meniere’s disease: a diagnostic and therapeutic dilemma. Laryngoscope 1986;96:9–13.

36. Brookler KH, Glenn MB. Meniere’s syndrome: an approach to therapy. Ear Nose Throat J 1995;74:534–8, 540, 542.

37. Clostre F. Ginkgo biloba extract (EGb 761). State of knowledge in the dawn of the year 2000. Ann Pharm Fr 1999 ;57:1S8–88 [review; in French].

38. Franz B, Altidis P, Altidis B, Collis-Brown G. The cervicogenic otoocular syndrome: A suspected forerunner of Meniere’s disease. Int Tinnitus J 1999;5:125–130.

39. Bjorne A, Berven A, Agerberg G. Cervical signs and symptoms in patients with Meniere’s disease: a controlled study. Cranio 1998;16:194–202.

40. Bjorne A, Agerberg G. Craniomandibular disorders in patients with Meniere’s disease. A controlled study. J Orofacial Pain 1996;10:28–37.

41. Franz B, Altidis P, Altidis B, Collis-Brown G. The cervicogenic otoocular syndrome: A suspected forerunner of Meniere’s disease. Int Tinnitus J 1999;5:125–130.

42. Bracher ES, Almeida CI, Almeida RR, et al. A combined approach for the treatment of cervical vertigo. J Manipulative Physiol Ther 2000;23:96–100.

43. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. Eur Spine J 1998;7:55–8.

44. Hulse M, Holzl M. [No title available] HNO 2000;48:295–301 [in German].

45. Hagnebo C, Andersson G, Melin L. Correlates of vertigo attacks in Meniere’s disease. Psychother Psychosom 1998;67:311–6.

46. Hagnebo C, Melin L, Larsen HC, et al. The influence of vertigo, hearing impairment and tinnitus on the daily life of Meniere patients. Scand Audiol 1997;26:69–76.

47. House JW, Crary WG, Wexler M. The inter-relationship of vertigo and stress. Otolaryngol Clin North Am 1980;13:625–9.

48. Wiet RJ, Kazan R, Shambaugh GE Jr. An holistic approach to Meniere’s disease. Medical and surgical management. Laryngoscope 1981;91:1647–56.

49. Andersson G, Hagnebo C, Yardley L. Stress and symptoms of Meniere’s disease: a time-series analysis. J Psychosom Res 1997;43:595–603.

50. House JW, Crary WG, Wexler M. The inter-relationship of vertigo and stress. Otolaryngol Clin North Am 1980;13:625–9.

51. Andersson G, Hagnebo C, Yardley L. Stress and symptoms of Meniere’s disease: a time-series analysis. J Psychosom Res 1997;43:595–603.

52. Andersson G, Hagnebo C, Yardley L. Stress and symptoms of Meniere’s disease: a time-series analysis. J Psychosom Res 1997;43:595–603.

53. Sawada S, Takeda T, Saito H. Antidiuretic hormone and psychosomatic aspects in Meniere’s disease. Acta Otolaryngol 1997;528:109–12.

54. Scott B, Lindberg P, Lyttkens L, Melin L. Psychological treatment of tinnitus. An experimental group study. Scand Audiol 1985;14:223–30.

55. Clendaniel RA, Tucci DL. Vestibular rehabilitation strategies in Meniere’s disease. Otolaryngol Clin North Am 1997;30:1145–58.

56. Kaada B, Hognestad S, Havstad J. Transcutaneous nerve stimulation (TNS) in tinnitus. Scand Audiol 1989;18:211–7.

57. Steenerson R, Cronin GW. Treatment of tinnitus with electrical stimulation. Otolaryngol Head Neck Surg 1999;121:511–3.

58. Scott B, Larsen HC, Lyttkens L, Melin L. An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Meniere’s disease. Br J Audiol 1994;28:131–40.

59. Kaada B, Hognestad S, Havstad J. Transcutaneous nerve stimulation (TNS) in tinnitus. Scand Audiol 1989;18:211–7.

60. Steenerson R, Cronin GW. Treatment of tinnitus with electrical stimulation. Otolaryngol Head Neck Surg 1999;121:511–3.

61. Scott B, Larsen HC, Lyttkens L, Melin L. An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Meniere’s disease. Br J Audiol 1994;28:131–40.

62. Yan SM. Acupuncture for Meniere’s syndrome: short- and long-term observation of 189 cases. Int J Acupunct 1999;10:303–4.

63. Steinberger A, Pansini M. The treatment of Meniere’s disease by acupuncture. Am J Chin Med 1983;11(1–4):102–5.

64. Steinberger A, Pansini M. The treatment of Meniere’s disease by acupuncture. Am J Chin Med 1983;11(1–4):102–5.
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