Ménière’s disease is a rare problem that affects the inner ear. It starts with attacks of vertigo, dizziness and tinnitus and can then progress through different stages, sometimes resulting in hearing loss.

Around one in 1,000 people develop Ménière’s disease and symptoms usually start in people aged between 40 and 60. Around 30% more women than men are affected and a small number of cases (about one in 20) seem to run in families so may have a genetic component.

What are the symptoms of Ménière’s disease?

The most distressing symptom of Ménière’s disease is vertigo. This is an extreme form of dizziness in which the world seems to be spinning around you or spinning away from you. It can cause you to feel sick and  to vomit. Attacks come on without warning and can last 2-3 hours, making it very difficult to function and plan daily activities.

Other symptoms experienced during an attack include:

  • Tinnitus: hearing a high-pitched ringing sound inside your head, which can be very loud and from which you cannot escape.
  • Hearing loss: this may be partial or total. When partial, usually it is the low frequency sounds that become undetectable. Hearing loss is more common in the later stages of Ménière’s disease.
  • Aural fullness: this is a feeling of pressure within the inner ear.
  • Palpitations: your heart can start racing and thumping. This is often accompanied by a cold sweat and anxiety.

Stages of Ménière’s disease

Ménière’s disease typically develops through three stages:

  • Stage 1 Ménière’s disease: attacks of vertigo and tinnitus last from about 20 minutes to 2-3 hours but it may take a day or two to feel completely well again. It is common to have up to a dozen attacks a year. Hearing returns to normal between attacks but because the attacks occur without warning, the fear of an attack impacts on quality of life most of the time.
  • Stage 2 Ménière’s disease: attacks continue, but vertigo becomes less severe; tinnitus and hearing loss may become progressively worse. You may experience long periods of remission of up to several months in which symptoms are absent.
  • Stage 3 Ménière’s disease: vertigo becomes less common and may cease entirely, but you may suffer from balance problems that become permanent. Tinnitus and hearing loss may become progressively worse.

What causes Ménière’s disease?

The exact cause of Ménière’s disease is not yet understood. There is a theory that the condition arises due to an imbalance in pressure within different parts of the inner ear, but this has not been established beyond all doubt.

It is clear that there are several risk factors other than genetics that may make someone more susceptible to developing Ménière’s disease but the exact mechanisms involved remain rather hazy:

  • Infection with a virus: having viral meningitis is a known risk factor.
  • Blood vessel problems: Ménière’s disease is linked to migraine in some people and the swelling of blood vessels in the brain may be a factor.
  • Autoimmune diseases: some cases of Ménière’s may be due to the body’s immune system attacking components of the inner ear.

There are also suspicions that stress, excess alcohol, smoking and caffeine can make symptoms of Ménière’s disease worse.

How is Ménière’s disease diagnosed?

Getting a definite diagnosis of Ménière’s disease can be difficult because there is no specific test that shows that you have it. Your GP will examine you and will want to rule out other possible causes of your symptoms, such as an ear infection, migraines or other inner ear conditions such as labyrinthitis.

He or she may ask you to keep a diary to describe your attacks including how frequently they occur, how long they last and all of the symptoms that you experience.

You can have a hearing test to check for hearing loss but this can only really detect the later stages of Ménière’s disease in many cases. You may find that your hearing is normal most of the time and only deteriorates during attacks.

Diagnosis of Ménière’s disease can therefore take time and you may need to be referred to an ear, nose and throat specialist. Fortunately, in the meantime, the worst of your symptoms can be treated so that you can feel more comfortable during the attacks.