Sign up
Log in
EspañolSave big on your prescriptions.
Get the free SingleCare app
Get the free SingleCare app
Always free for consumers
Quickly access discount cards
Over a billion dollars saved
4.8 average rating
Text a link to download the app
Phone number
Scan to download the app
Meniere’s disease is a puzzling and chronic condition of the inner ear. When it first manifests, vertigo attacks can come on suddenly. Fortunately, these attacks abate as the condition progresses, but only to be replaced by hearing loss and balance problems. Living with Meniere’s will be a lifetime project, but treatments can help.
What is Meniere's disease?
Meniere’s disease is a condition in which fluid builds up in the inner ear. Swelling in the inner ear causes vertigo (spinning sensation and dizziness), ringing in the ears (tinnitus), hearing problems, and pressure or “fullness” in the ear. Meniere’s typically involves only one ear, but both ears can be affected in some cases. Meniere’s is a rare condition, but estimates vary widely because the condition is substantially underdiagnosed. According to The National Institute on Deafness and Other Communication Disorders (NIDCD), around 620,000 people in the U.S. have Meniere’s, and 45,500 are newly diagnosed every year.
Meniere’s is a chronic and slowly progressive disorder of the inner ear that can interfere with daily life. Severe cases can be disabling, making people unable to work or perform daily functions, such as driving. As a progressive disease, Meniere’s passes through three separate stages. In the earliest stage, vertigo attacks are the primary symptom, clustering in six to 11 episodes per year followed by a few months or even years of complete remission. In later stages, vertigo becomes less common. Most patients with Meniere’s don’t have vertigo attacks eight years after diagnosis. In the later stages, hearing loss and balance problems become the principal symptoms. For most patients, hearing loss can be corrected with hearing aids, but some patients will lose their hearing in the affected ear.
The inner ear is filled with a fluid called endolymph. It is produced by a gland called the endolymphatic sac and circulates through the three major structures in the inner ear; the cochlea, the vestibule, and the semicircular canals. The cochlea translates sounds into nerve signals to the brain. The other two structures sense the movement of the head and gravity and send those signals to the brain. All three structures use movement or disturbances in the endolymph to sense sound or movement.
In Meniere’s disease, the endolymphatic sac produces too much fluid, a condition known as endolymphatic hydrops. The swelling interferes with the ability of the inner ear to sense movement or sound, resulting in hearing loss and dizziness.
No one is certain what causes Meniere’s disease, but it is believed to be an autoimmune disorder. The body’s immune system, designed to attack foreign invaders, mistakenly targets the endolymphatic sac, resulting in an overproduction of endolymph.
How is Meniere's disease diagnosed?
The diagnosis of Meniere’s disease is made from an assessment of symptoms, hearing tests, eye tests, and imaging. Many patients may start with a general practitioner or emergency room physician, but the condition will be definitively diagnosed and treated by an otolaryngologist, a doctor who specializes in conditions of the ear, nose, and throat.The defining symptom of Meniere disease is unpredictable episodes of vertigo that last longer than 20 minutes. Vertigo feels like one’s head or the world is spinning around. In Meniere’s disease, vertigo can sometimes be severe, last for hours, and take several days to recover from.
Besides vertigo, other Meniere’s disease symptoms include:
- Ringing or roaring in the ear (tinnitus)
- Hearing loss
- Pressure in the ear
- Nausea and vomiting due to dizziness
- Uncontrolled horizontal eye movements (nystagmus)
“Drop attacks,” or sudden falls without loss of consciousness, are also common.
A healthcare provider will first try to identify if the problem is caused by the brain, the inner ear, or the circulatory system. To help determine the cause, be prepared to answer questions during the medical history such as:
- Are there hearing problems?
- Headaches?
- Does dizziness start when standing up suddenly?
- Have you had previous episodes of vertigo?
- Do you have ringing in the ears?
In the medical history, the doctor will also assess for risk factors for Meniere’s disease such as:
- Age
- Family history of inner ear problems
- Excess salt in the diet
- Stress
- Autoimmune disorders
- History of viral infections
- Allergies
A physical examination will include an ear exam, testing the facial nerves, and examining the eyes for involuntary movements.
The physician will test hearing with a tuning fork to determine which ear is affected and to determine if the inner ear or middle ear has a problem. Involuntary eye movements (nystagmus) will be measured by an electronystagmography (ENG) device, Frenzel goggles, or infrared goggles.
An otolaryngologist will perform a vestibular evoked myogenic potential (VEMP) test to measure how well the inner ear is working. Finally, all patients will undergo a full audiometric examination conducted by an audiologist to determine the exact nature of any hearing loss. Patients will also undergo a magnetic resonance imaging (MRI) to identify any possible nerve problems such as infections, tumors, swelling, or neurological issues.
Meniere's disease treatment options
Treatment of Meniere’s disease focuses either on lowering inner ear fluid (endolymphatic) or controlling symptoms. No treatment cures the disease, so treatment is a trade-off of improving symptoms with the fewest side effects. Treatment will start with the most conservative treatments: diet, physical therapy, and medications to control vertigo.
Low-sodium diet
Reducing sodium in the diet may help lower the fluid build-up in the inner ear, helping to prevent Meniere disease attacks. A salt-restricted diet is a first-line therapy for Meniere’s disease.
Vestibular rehabilitation
Physical therapy will focus on training the brain to use sensory clues other than the inner ear to maintain balance and prevent vertigo. These include exercises to practice balance, stabilize the gaze, reduce visual dependency for balance, and exercises that involve using the eyes along with head and body movements. Vestibular rehabilitation can be carried out by a vestibular rehabilitation specialist, a physical therapist, an audiologist, or done at home.
Meniett therapy
The Meniett device uses low-frequency air pulses to displace excess fluid in the ear. A small ventilation tube has to be inserted into the eardrum to allow the pulses to pass into the middle ear. Studies are mixed as to its effectiveness, but it may be useful as a second-line therapy for some patients. The device, however, must be used several times every day.
Medications
Medications can be used to treat or prevent episodes of vertigo, nausea, and tinnitus. Antivertigo drugs or vestibular suppressant agents primarily reduce the brain’s sensitivity to the nerve signals from the inner ear. Corticosteroid injections into the inner ear help reduce swelling. Finally, for people with severe vertigo attacks, gentamicin injections are used to kill off (ablate) inner ear tissues.
Surgery
Surgical procedures are used only for debilitating vertigo symptoms in cases that do not respond to less invasive procedures.
- Endolymphatic sac decompression and shunt: A surgeon will make an incision in the endolymphatic sac that allows fluid to drain out through a shunt. Alternatively, some surgeons may pinch the duct leading from the sac closed with metal clips. Endolymphatic sac decompression reduces Meniere’s symptoms while preserving hearing.
- Vestibular neurectomy (vestibular nerve section): A surgeon cuts the vestibular nerve that connects to the vestibular part of the inner ear to the brain. This cuts off the nerve signals that cause vertigo. Signals from the hearing part of the inner ear, the cochlea, are preserved. Hearing in the ear is not destroyed, but there may be some hearing loss.
- Labyrinthectomy: For the most debilitating cases, the surgeon will remove the semicircular canals, the vestibule, and the cochlea. A labyrinthectomy destroys all hearing in the affected ear, so it’s only reserved for patients with hearing loss so severe that it can’t be corrected with a hearing aid.
Meniere's disease medications
Medical treatment of Meniere’s either reduces fluid in the inner ear or is meant to control symptoms. Therapy will begin with the most conservative drugs—diuretics to reduce inner ear fluid and antihistamines to treat vertigo attacks.
Diuretics
Diuretics cause the body to shed excess fluid in the urine. These drugs help reduce the build-up of fluid in the inner ear to prevent and reduce. Diuretics are a first-line medical therapy along with a low-salt diet to reduce Meniere’s symptoms. The most commonly prescribed are Dyazide (triamterene and hydrochlorothiazide) and Diamox (acetazolamide).
Vestibular suppressants
Vestibular suppressants are used to control active episodes of dizziness and nausea brought on by an episode of vertigo. Although these medications belong to other drug classes, they all work by suppressing nerve signals from the inner ear balance organs.
Worldwide, the first-line therapy for Meniere’s vertigo attacks is betahistine, an antihistamine that reduces swelling and improves blood flow in the inner ear. However, betahistine is not available in the United States, so promethazine is more commonly prescribed as a first-line therapy for vertigo attacks. Meclizine is another drug that blocks histamines, but it works by slowing down the part of the central nervous system that responds to signals from the inner ear.
Other vestibular suppressants also work by slowing down the central nervous system. They include prochlorperazine (an antipsychotic), ondansetron (a drug that prevents nausea), benzodiazepines (diazepam or lorazepam), and antidepressants such as amitriptyline. However, these drugs can have serious and frequently-experienced side effects.
Corticosteroids
A small-dose injection of a corticosteroid, such as methylprednisolone or dexamethasone, through the eardrum into the inner ear will block substances that cause swelling. Symptom remission can be rapid and last for several weeks. The effects, however, are not permanent. Some otolaryngology doctors may prescribe oral steroids for Meniere’s, but this is rare.
Aminoglycoside antibiotics
Aminoglycosides are antibiotics—drugs used to treat bacterial infections—that are toxic to the inner ear, that is, they kill cells in the inner ear. Gentamicin is the preferred drug because it primarily kills off vestibular (balance) cells rather than cochlear (hearing) cells, so it may be less likely to affect hearing. The idea is to weaken vestibular signals to the brain to the point where they no longer provoke vertigo or nausea. Gentamicin is typically injected through the eardrum and removed from the inner ear after about 30 minutes. Low-dose or high-dose injections are repeated daily, weekly, or monthly until vertigo episodes have subsided. The injections are then discontinued when vertigo attacks have abated. There is no standard protocol or dosage; some healthcare providers will only use a single low-dose injection.
What is the best medication for Meniere's disease?
Meniere’s disease is not perfectly understood. For this reason, medications are used to relieve symptoms of Meniere’s while minimizing side effects. Not every medicine works the same in every person, so there is no best medication for Meniere’s.
| Best medications for Meniere’s disease | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Dyazide (triamterene and hydrochlorothiazide) | Diuretic | Oral | 37.5 mg triamterene 25 mg hydrochlorothiazide or 75 mg triamterene 50 mg hydrochlorothiazide once per day | Dizziness, lightheadedness, headache |
| Diamox (acetazolamide) | Diuretic | Oral | 250 mg per day to start. Dosage may be increased depending on patient response. | Dizziness, lightheadedness, dry mouth |
| Phenergan/Promethegan (promethazine) | Antihistamine (vestibular suppressant) | Oral or rectal | 25 mg orally or rectally every four to six hours as needed | Nausea, dry mouth, dizziness |
| Antivert (meclizine) | Antihistamine (vestibular suppressant) | Oral | 25 mg to 100 mg in divided doses daily | Drowsiness, dry mouth, headache |
| Compazine (prochlorperazine) | Antipsychotic (vestibular suppressant) | Oral | 5 mg or 10 mg three to four times daily | Drowsiness, blurred vision, dry mouth |
| Ativan (lorazepam) | Benzodiazepine (vestibular suppressant) | Oral | 0.5 to 2 mg every four to eight hours | Drowsiness, dizziness, sleep problems |
| Elavil (amitriptyline) | Antidepressant (vestibular suppressant) | Oral | 10 mg at bedtime | Weight gain, constipation, headache |
| Zofran (ondansetron) | Antiemetic(vestibular suppressant) | Oral | 8 mg every 12 hours | Headache, constipation, diarrhea |
| Decadron (dexamethasone) | Corticosteroid | Intratympanic injection | 4 mg/ml to 10 mg/ml intermittently | Fluid retention, difficulty sleeping, mood and behavior changes |
| Garamycin (gentamicin) | Antibiotic | Intratympanic injection | 0.5 ml of 20 mg/ml solution once weekly. Dosage and schedule may vary. | Permanent hearing loss |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA),the Prescriber’s Desk Reference (PDR), or off-label studies for the treatment of Meniere’s. Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of Meniere's disease medication?
Different types of medications have different side effects, so this is not a complete list of the side effects of Meniere’s disease medications. If you are concerned about side effects, a healthcare professional can advise you about possible side effects and drug interactions based on your specific situation.
Diuretics
The side effects of diuretics are primarily related to dehydration and electrolyte loss and include muscle cramps, headaches, dizziness, and joint problems. The most serious side effects include low blood potassium, liver damage, and certain types of kidney stones.
Vestibular suppressants
Side effects depend on the type of vestibular suppressant prescribed. All vestibular suppressants, including antihistamines, slow down the central nervous system, so drowsiness, dizziness, and sedation are frequent side effects. All of these drugs can also cause dry mouth, nausea, vomiting, vision problems, and nervousness or agitation.
Corticosteroids
Most Meniere’s disease injections involve infrequent, highly-localized, low-dose injections, so side effects other than injection reactions, such as pain or irritation, are rare or only minimal. A doctor may prescribe oral corticosteroids. They are, however, less effective and have side effects such as mood or behavior changes, aggression, elevated blood pressure, glaucoma, and fluid retention.
Aminoglycosides
The most serious side effects of gentamicin are hearing loss and kidney damage. About 30% of patients will experience permanent hearing loss from gentamicin treatment for Meniere’s. However, the most commonly-used therapy is to use low-dose or ultra-low-dose gentamicin injections once or month or less frequently. This produces few side effects and preserves hearing in most patients.
What is the best home remedy for Meniere's disease?
Lifestyle changes are the primary self-remedy to lower inner ear pressure and control symptoms of Meniere’s. The key is consistency, so commit to:
- Reduce salt intake the most universally-advised home remedy for Meniere’s is to reduce salt intake to 1,000 to 2,000 mg of salt per day to help reduce fluid build-up in the ear.
- Avoid caffeine, alcohol, and tobacco products they can all make Meniere’s symptoms worse. Caffeine and alcohol can affect fluid regulation while nicotine in tobacco products can constrict blood vessels and affect blood flow within the ear.
- Manage your allergies allergic reactions may bring on Meniere’s attacks, so control seasonal allergies and avoid foods you are sensitive to.
- Manage stress stress seems to bring on Meniere’s attacks, so practice relaxation techniques, meditation, yoga, Tai Chi, and breathing exercises.
- Exercise regularly use vestibular rehabilitation exercises even if you’re not in physical therapy. You can learn these exercises online.
Frequently asked questions about Meniere's disease
What can trigger an attack of Meniere's disease?
There are no set triggers for Meniere’s attacks, but some people may have attacks consistently set off by stress, allergic reactions, negative emotions, or eating too much salt.
What not to eat when you have Meniere's?
All patients with Meniere’s should limit salt intake. No more than two grams of salt should be consumed daily, but you should aim for 1.5 grams daily. To put that number in perspective, you will motor past 1.5 grams of salt by eating three hot dogs (without the bun), two to three slices of pizza, or two fast-food cheeseburgers. The major offenders are processed foods, fast foods, and canned foods. Eat fresh fruits, vegetables, and meats instead.
What is the best medication for Meniere's disease?
The goal of treatment for Meniere’s is to reduce symptoms without causing side effects. Medications will start with antihistamines to control vertigo episodes and diuretics to reduce inner ear fluid build-up. Corticosteroid injections can provide relief from Meniere’s attacks for a few months, and gentamicin injections may be able to provide long-lasting relief. However, both come with more serious side effects including permanent loss of hearing.
Does Meniere's ever go away?
Meniere’s is a chronic and slowly progressive disease. There is no cure. For most people, vertigo attacks will become dramatically less frequent or stop altogether five to eight years after the first symptoms. However, tinnitus and hearing loss will become much worse in the later stages of the condition.
Does everyone with Meniere's go deaf?
Most people with Meniere’s disease will have some permanent hearing loss. Only rarely is the loss severe enough that it cannot be corrected with a hearing aid.
How long does Meniere's disease last?
Meniere’s is a lifelong, chronic, and progressive condition of the inner ear.
How quickly does Meniere's progress?
Meniere’s is a slowly progressing condition that takes several years to advance to later stages. However, not all patients progress through the condition in the same way or on the same timeline.
How did I get Meniere's disease?
The cause of Meniere’s is not understood. It may be related to genetics, allergies, infection, trauma, or any combination of these.
Is Meniere's a disability?
Meniere’s disease qualifies as a disability when a person who meets all the diagnostic criteria is unable to work. The patient must also meet certain thresholds on vestibular tests and audiometric (hearing) tests. Applicants will need to have a detailed history of the frequency as well as the intensity of attacks going back months and years. Disability determination will also be based on transferable skills, work history, and age.
Is Meniere's hereditary?
Meniere’s may be genetic. Having a family member with Meniere’s does raise the risk of getting the condition. However, the genetics of Meniere’s is poorly understood.
Are there any new treatments for Meniere's?
The most promising new treatment on the horizon is ebselen, a small molecule that works as an antioxidant. Early clinical trials show that it may partially restore hearing in patients with drug-induced hearing loss or Meniere’s disease. It’s still in the early stages of clinical trials and has a long way to go before anyone is certain of its effectiveness.
Can Meniere's disease be treated with acupuncture?
Meniere’s is a lifelong, progressive condition with no known cure. It is perfectly reasonable, then, for people with Meniere’s to try as many treatments as possible. This includes alternative or complementary treatments such as acupuncture, moxibustion, chiropractic manipulation, massage, herbs, and essential oils. If it doesn’t do any harm, it’s probably worth a try. Unfortunately, there is no research showing that any alternative therapy can help cure Meniere’s or relieve the symptoms. None of these alternative therapies have commonly-practiced standards for treating Meniere’s. For instance, one acupuncturist will probably not use the same treatment as another acupuncturist. If an alternative therapy can help, it will depend on the practitioner and the person’s response to the treatment. Consult your healthcare provider before trying alternative therapies.