Introduction
Meniere’s disease is an inner-ear condition that can cause vertigo, a specific type of dizziness in which the patient feels like he is spinning himself. It also can cause ringing in ear (tinnitus), hearing loss that comes and goes, and a feeling of fullness or pressure in ear. It tends to strike men and women equally, and although it can occur at any age, it usually begins between the ages of 30 and 50. In most cases, only one ear is affected. Only about 15 percent of people with Meniere’s disease lose hearing in both ears. The hearing loss eventually can be permanent. The disorder takes its name from a French doctor, Prosper Meniere, who suggested in the 1860s that the symptoms came from the inner ear and not the brain, as most people believed.
Signs & symptoms
The symptoms of Meniere’s disease vary in individuals. Some patients experience an episode of attack for a few weeks followed by years of relief, and other patients experience symptoms regularly for years.
A person with Meniere’s disease may experience any or all of these symptoms:
- Vertigo and dizziness – very severe that the person has to stop all the activities for the moment and seek help. There may be a sense that the room is spinning, twisting or rocking. Balance can be severely affected. The sensation can last from a few minutes to several hours. After the vertigo goes away, a sense of imbalance can remain for hours or days.
- Nausea and vomiting during an episode of vertigo.
- A feeling of pressure or fullness in the affected ear.
- Ringing, buzzing or other noises in the affected ear (tinnitus). This ringing is often low-pitched and may distort normal sounds.
- Hearing loss that comes and goes, but gets progressively worse over time. Low-pitched hearing often is affected earlier in the disease.
Along with the main symptoms, some people may have:
Anxiety
Blurred vision
Diarrhoea
Nausea & vomiting
Trembling/ shaking of body
Cold sweat
Rapid pulse and palpitations
Causes
The cause of Meniere’s disease isn’t known.
Many theories about what might affect the fluid in the inner ear, includes:
- Poor drainage (because of blockage or an abnormal structure in your ear)
- Autoimmune response (when your body’s defence system attacks healthy cells)
- Allergic reaction
- Viral infection
- Inherited tendency
- Blow to the head
- Migraine headaches
In Meniere’s disease, fluid collects in the inner ear. Pressure from the build-up of fluid and damage to some of the delicate structures in the inner ear can cause a variety of symptoms. Fluid build-up is inside a part of inner ear called the labyrinth, which holds structures that help with hearing and balance. The extra fluid interferes with the signals the brain receives, causing vertigo and hearing problems. Symptoms usually appear suddenly, without warning, and can last minutes to hours. Many people have only mild symptoms, but in others the symptoms are severe enough to be disabling. Hearing loss comes and goes, but over time some degree of hearing loss may become permanent.
Diagnosis
Diagnosis of Meniere’s disease is difficult, as the doctor cannot examine the inner ear directly. Usually, the diagnosis is made by typical symptoms and ruling out other possible causes of the symptoms.
Tests that may be used to aid in diagnosis include:
- A hearing test/audiometry
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Electronystagmography or rotational testing
There is no cure for Ménière’s disease, so aim of the treatment is to control symptoms.
A hearing aid may help, and some treatments can ease both your vertigo and the fluid build-up inside the ear.
Different types of medications are used, including:
- Anti-vertigo medications, such as meclizine or betahistine, to relieve or prevent vertigo and dizziness
- Antinausea medications, such as prochlorperazine, to relieve nausea and vomiting
- Diuretics, such as hydrochlorothiazide, to reduce the amount of fluid that builds in the inner ear
Avoiding caffeine, alcohol, salt and nicotine to reduce the frequency or severity of attacks.
Other Therapies
In addition to medication, you might try therapy targeted to help with balance issues.
- Physical therapy. A physical therapist will give you a series of exercises that, when done routinely, can help with imbalance, dizziness, and other issues. Staying active and getting exercise, like walking, can help, too, especially after you finish PT.
- Vestibular rehabilitation therapy. VRT is an exercise program that retrains your brain to use other senses, such as your vision, to help with your balance.
- Positive pressure therapy (Meniett device). This approach uses a device to apply pressure to your ear canal through a tube. This improves how fluid moves through your ear. You can do these treatments at home.
In severe cases, injections of gentamicin into the middle ear are administered. A side effect of gentamicin (a potent intravenous antibiotic) is damage to the balancing mechanism inside the ear. By selectively destroying the balancing parts, the condition may actually improve. Single to multiple injections may be necessary to damage the inner ear enough to stop the vertigo episodes.
Surgery will be suggested if symptoms of vertigo are severe or frequent. Different surgical procedures are available, each with pros and cons. For example, some types of surgery will destroy parts of the inner ear, which can cause permanent hearing loss. Surgical procedures that may be recommended in severe cases include:
- Selective vestibular neurectomy, in which the nerve that runs from the inner ear to the brain is cut
- Endolymphatic shunt, in which a tiny hole is cut in the inner ear to help clear out some of the accumulated fluid
No treatment can prevent the hearing loss that occurs in Meniere’s disease.
Prognosis
There is no cure for Meniere’s disease. Once the condition is diagnosed, it will remain for life. However, the symptoms typically come and go, and only some people with Meniere’s disease will go on to develop permanent disabilities. Over time, some degree of permanent hearing loss is common. However, the worst symptoms of vertigo, nausea and vomiting often can be controlled. By working closely with their physicians, people with Meniere’s disease often can find the right combination of lifestyle changes and medication to reduce the frequency and severity of attacks.
Complications
- Injury due to falls.
- Anxiety regarding symptoms.
- Accidents due to vertigo spells.
- Disability due to unpredictable vertigo.
- Progressive imbalance and deafness.
- Intractable tinnitus
Disease & Ayurveda
There is no single correlation to Meniere’s disease in Ayurveda. But the signs and symptoms come together with three diseases explained in the ayurvedic textbooks namely, Bhrama, Karnanada, and Badhirya
Nidana
Causative factors for the vitiation of Pitta and Vaata like:
Lack of sleep
Changes in position
Malnourishment and emaciation
Excess bleeding
Trauma
Purvaaroopa
Not mentioned
Samprapti
Due to causative factors, vitiated doshas mainly Vaata and Pitta when get lodged in ear and samjnavahasrotas the person feels giddiness, tinnitus, hearing loss etc.
Lakshana
Chakravath bhramathe – Feeling of revolving like a wheel, of self and surroundings
Karna nada – Hearing buzzing type sound in the ear
Badhirya – Hearing loss
Divisions
Not mentioned
Prognosis
Yaapya/Kricchrasaadhya
Chikithsa
In Ayurveda, considering the sites of Doshas, diseases of head need to be treated considering Kaphadosha, diseases of ear should be treated with Vaatadosha in account. As there are two options, degeneration or obstruction to the channels for the vitiation of Vaata, treatment should be decided considering which type of cause present in the ear of the patient.
If the ear and associated areas present with an obstruction of channels, drying up of the swelling and inflammatory pus discharge should be done.
If the disease developed due to degeneration as in old age or trauma, nourishment should be given to the ear.
In the meantime, any obstruction in channels or aama in the body should also be addressed with proper medicine and therapy.
Samana
Lepana-external application of herbal paste
Dhoopana-herbal fumigation into the ear
Karnapoorana-filling the ear canal with medicated oils etc.
Thalam-application of herbal paste or oil on vertex
Pichu-application of cloth soaked in medicated oil on vertex
Sodhana
Nasya-nasal drops
Vamana-medically induced vomiting for therapeutic purpose
Virechana- medically induced purgation for therapeutic purpose
Asthapana vasti-herbal enema with decoction mixture
Anuvasanavasti-herbal enema with medicated oil
Commonly used medicines
Guggulupanchapalachoornam
Varanadi kashayam
Dhanwantharam Tailam
Bala Tailam
Ksheerbala Tailam
Mridweekadi kashayam
Drakshadi kashayam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There is no proven home remedy to cure Meniere’s disease, but a few things can help manage the symptoms.
While having an attack of vertigo:
- Try to sit down and stay still.
- Don’t make sudden movements.
- Avoid bright light, loud noise, and other triggers. Watching TV or even reading also can be harmful.
- Close your eyes and fix your gaze on something steady.
In addition to eating a low-salt diet, you may want to cut down on alcohol and caffeine. Some people think such diet changes lessen the effects of the disease. Tobacco use also can be harmful, as cigarettes have chemicals which restrict blood vessels. If this happens in ears, it can lead to hearing loss.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups.
Fresh fruits
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Avoid stress
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Change in position can cause worsening of signs in Meniere’s disease. So, vigorous and fast movements should be avoided. In severe conditions, no exercises or yoga postures are advised. But in mild cases and in asymptomatic conditions, stabilising yoga postures like Vajrasana, padmasana, savasana etc. are advised.
Vajrasana
Padmasana
Savasana
Yoga and simple exercises to help improve balancing in Meniere’s disease
Research articles
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