"I'm so dizzy, my head is spinning
Like a whirlpool, it never ends
And it's you, girl, making it spin
You're making me dizzy."
Roe was singing about love in the song. But he may well have been describing Meniere’s disease because that’s what the condition feels like.
A disorder of the inner ear, Meniere’s disease creates a sensation of spinning. The condition is often accompanied by hearing loss, a constant ringing sound in the ear, and a feeling of pressure or fullness in the ear.
The technical terms for the symptoms are vertigo and tinnitus. But for those afflicted with the disease, the symptoms equate to misery because they compromise not only hearing, but also the ability to function and get a good night’s sleep. Meniere’s disease is estimated to affect 3 million to 5 million people in the United States.
Meniere’s disease happens at any age but typically affects those between ages 20 and 50. It often affects only one ear, but is a chronic condition, and while it may disappear for long stretches, even years, it typically comes back at some point.
Signs of Meniere’s Disease
The symptoms of Meniere’s disease often occur gradually, but their impact on lifestyles and work can be debilitating. They include:
1) Recurring vertigo – Imagine yourself on a merry-go-round that stops and starts without warning, and you’ll get the idea of vertigo. Episodes during Meniere’s attacks can range from 20 minutes to 24 hours, and the severity varies from mildly annoying to causing vomiting and nausea.
2) Hearing loss – This can fade in and out in the early stages, but eventually becomes permanent in most cases.
3) Tinnitus – Imagine ringing, buzzing, roaring, whistling or hissing sounds in the ear, and you’ll have a good idea of tinnitus. Some people live with the condition, but others are emotionally upset by the inability to escape the sounds.
4) Fullness in the ear – This can manifest as a pressure in the ear or be felt on the side of the head.
5) Inability to focus – Because Meniere’s disease affects balance, the ability to pinpoint objects across a room can become distorted.
Diagnosing Meniere's Disease
Any Meniere’s symptoms can be indications of other diseases or medical problems, so it is important to get an official diagnosis. The disease is usually marked by an abnormal amount of fluid in the inner ear, a condition that is only discovered during autopsies. However, not every medical professional is convinced that fluid is the cause of Meniere’s disease, and there is still much debate over its cause.
If fluid is the cause, the volume of fluid may be affected by several factors, including:
1) Improper drainage – Fluid usually is present in the inner ear, but if there is a blockage or other inability to clear it, problems can arise
2) Allergies – Some allergic reactions cause fluid buildup, but it usually drains. With Meniere’s, something blocks it.
3) Abnormal immune response – The fluid buildup may indicate that something has changed normal reactions to outside stimulus.
4) Viral infection – This may explain the fact that Meniere’s disease comes and goes.
5) Genetic predisposition – Because Meniere’s tends to run in families, there may be a gene grouping that triggers the disease.
6) Head trauma – This would fall under the blockage or inability to clear fluid. Sharp blows to the head obviously have the potential to change delicate pathways.
7) Migraines – Fluid buildup puts pressure on areas that influence migraines.
Most researchers believe one or more factors acting in combination are the triggers for Meniere’s disease. Once the disease takes hold, it has the added negatives of creating emotional stress, depression, anxiety and fatigue.
Family doctors typically will refer a patient to an ear, nose and throat specialist, hearing specialist or a nervous system specialist for additional tests and diagnosis before a formal finding of Meniere’s disease is established.
There was some recent good news for Meniere’s disease sufferers. Researchers at the University of Colorado School of Medicine have discovered a strong tie between conditions that create low blood flow to the brain and Meniere’s disease. The condition seems to arise from two conditions – a malformation of the inner ear aligning with patients who have a risk for vascular diseases in the brain, including sleep apnea, migraines and atherosclerosis.
Inner Ear Pressure
In patients with Meniere’s disease, it seems there’s a problem with pressure regulation in the inner ear when fluid builds up. This causes decreases in blood flow within the ear, and when combined with vascular problems that limit blood flow to the brain and ear, there can be a sudden loss of blood flow similar to a miniature stroke. In young people, this usually isn't a problem because blood flow will continue. But add in the vascular disorders, and problems arise. The tissues that are used for hearing and balance are starved of blood, stop sending signals to the brain, and create the symptoms of vertigo, tinnitus and hearing loss.
Unfortunately, restoring blood flow does not cure the problem, and any treatment to do so can trigger other problems. More research needs to be done before any form of reliable treatment or cure is developed, although a clear pathway to an eventual solution may emerge from these findings. Because no single cause has been identified, it's likely that Meniere's disease results from a combination of factors.
The unpredictable episodes of vertigo and the prospect of permanent hearing loss can be the most difficult problems of Meniere's disease. The disease can interrupt life and cause fatigue, emotional stress, depression and anxiety.
Testing for Meniere's Disease
During an examination for Meniere’s disease, doctors likely will perform a hearing test (audiometry), which will ask you to react to tones set at different pitch levels, ranging from low to high, and may ask you to distinguish similar-sounding words verbally. Meniere’s patients often struggle with low frequencies or combined high and low frequencies that occur in normal conversation.
To check balance, doctors may perform several tests. The first is a videonystagmography, which evaluates balance using eye movements. Warm and cool water are inserted into the ear canal, and then a special pair of video goggles measures involuntary eye movements.
A rotary chair test measures balance via a computer-controlled chair. The motion will stimulate the inner ear, checking reactions to the motion.
A vestibular evoked myogenic potentials test (sometimes called a VEMP test) checks to see changes in the inner ear using imaging. Similarly, posturography will test which units of the balancing system – the inner ear, vision, muscles, tendons and joints – are most affected by motion. This requires standing on a platform in bare feet and maintaining balance while the platform moves. Patients wear a safety harness to prevent falls.
Finally, an electrocochleography test looks at the inner ear’s response to sounds.
Doctors may request blood tests and other exams to rule out certain other conditions that mimic Meniere’s symptoms, including brain tumors and multiple sclerosis. Imaging exams of the brain will be used to determine that outcome.
Treatment for Meniere's Disease
While no cure currently exists for Meniere’s disease, there are treatments that can ease its symptoms, particularly with vertigo. But no cure for hearing loss is available. To treat the motion and balance issues, doctors typically will recommend meclizine or diazepam (Valium), two motion sickness medications that can control vomiting and nausea while reducing the spinning sensations. They also may recommend promethazine, which can help control nausea and vomiting in severe spinning instances.
Diuretics may be used to help reduce fluid retention, and that may be enough to control the severity and frequency of a Meniere’s attack. Reducing salt consumption is usually recommended as well to reduce fluid retention.
There are non-surgical treatments, such as a Meniett device that can help with vertigo; middle ear injections that can help with fluid problems; and surgical treatments that can help with vertigo issues.
Ultimately, Meniere’s disease sufferers will have to take precautions and make lifestyle adjustments to cope with the condition. However, treatment will enable most to live a relatively normal life.
So take Tommy Roes’s advice from his song: “I need to call a doctor for some help.”