Diagnosis of Meniere's Disease

Progression of Meniere's Disease

In the early phase of Meniere's disease, the predominant symptom is vertigo, often associated with nausea and vomiting. Pallor and sweating may also occur. The episode is often preceded by a feeling of fullness or pressure in the ear or side of the head as well as hearing loss and ringing in the affected ear. Vertigo begins quickly and grows in intensity as the attack progresses. The episode usually lasts from 20 minutes to several hours and for as long as 24 hours, though this is not common. Typically, movement during the attack exacerbates the nausea so patients usually want to lie motionless during an attack. Between the attacks hearing usually reverts to normal.

As the disease advances, the hearing loss in the lower frequencies progresses but continues to fluctuate during attacks. Episodes of vertigo eventually reach maximum severity, typically after a few years, and then tend to become less severe although a feeling of unsteadiness may persist. In the later stage of Meniere's, the hearing loss ceases to fluctuate during attacks and becomes progressively worse, and in some cases, may affect both ears (bilateral Meniere's disease). Patients may complain of hyperacusis (hypersensitivity to loud sounds) or recruitment (hypersensitivity to all sounds). If Meniere's disease becomes bilateral, then hearing loss becomes a major disability.

The AAO-HNS describes the stages of Meniere's disease based on the variable of hearing loss since this is the only quantifiable symptom. Stages are determined by the amount of hearing loss (ranging from early stage Meniere's disease with a loss of 25dB (decibels) or less to late stage with a hearing loss of 70dB or more) while listening to tones at four different frequencies which are averaged together.

There is no consistent pattern for Meniere's disease. Meniere's disease can be progressive or non-progressive and, for many people, vertigo attacks occur for the first 2-3 years after which labyrinthine function stabilizes. During this time, vertigo can usually be controlled by medication. In approximately 1 out of 4 patients, progression of vertigo continues despite medical treatment and reaches a point where the vertigo is refractory to treatment and is incapacitating. At that point, the patient may be considered a candidate for surgery. In rare cases, vertigo is so severe that the patient drops violently to the ground when the episode begins. This is called "Crisis of Tumarkin" or otolithic crisis).

Ninety-six percent of the patients surveyed in one study indicated that vertigo was the most distressing and incapacitating symptom of Meniere's disease. It is usually the major symptom that causes people to go to the doctor. The frequency and intensity of vertigo attacks is typically the sign used to describe the severity of Meniere's disease. It is associated with low scores on scales of daily functioning and usually has a significant affect on daily activities and quality of life. Fear of falling or fear of causing or exacerbating the sense of spinning with the slightest head movements may cause some patients to lose confidence in their ability to function with daily tasks as they live in constant fear of the next attack. For such patients, vertigo can be totally incapacitating.

Between episodes, vertigo completely disappears though patients may report dizziness, nausea, fatigue, depression, a "brain fog" or a sense of being disoriented, or memory loss. Unsteadiness may persist for several days, hearing loss may progresses and tinnitus can remain a problem.

Many patients with Meniere's disease go into remission with some or all of their symptoms (except for existing hearing loss) disappearing for long periods of time. Complete or partial remission is said to occur in approximately 60-80% of patients with Meniere's disease. When Meniere's disease disappears only after many years but leaves the patient with a permanent hearing loss and a feeling of unsteadiness it is known as "burned-out" Meniere's.