Meniere’s disease is a chronic condition of the inner ear causing episodes of vertigo and sensorineural hearing loss.  The nerve hearing loss fluctuates with each dizzy spell, and there is usually tinnitus- ringing in the ear.  Most patients experience fullness or pressure in the ear.  After repeated episodes there is usually some degree of permanent hearing loss.   
 
This complex of inner ear symptoms can mild or in some instances severe.  Dizziness is usually the predominant symptom.  Severe or frequent dizziness can greatly interfere with normal life, putting the patient at risk of falls, or accidents.  Fortunately there is usually at least a few minutes of warning (ear pressure, tinnitus or hearing loss) prior to the start of the episode of vertigo.  The vertigo usually lasts a few hours but may last a day or more.  There is usually nausea, often vomiting, and any motion makes the dizziness worse. 
 
In Meniere's disease the ear has lost its ability to regulate inner ear fluids, however the underlying cause of this is not known.  Testing to confirm the diagnosis usually includes repeated audiograms, computerized hearing tests (ABR, ECoG), balance function tests (ENG), and possibly other testing. 
 
Treatment requires salt and caffeine restriction as these substances interfere with fluid regulation.  During an episode of dizziness, vestibular suppressants are used to sedate the part of the brain involved with balance and reduce dizziness.  Meclizine, valium, dramamine or similar drugs can be taken by mouth.  Suppositories are available if there is vomiting.  A diuretic (fluid pill) taken daily can prevent or greatly reduce dizziness in most cases. Other medications may be prescribed by some Otolaryngologists, however there is disagreement on the usefulness of these.  While treatment is usually very helpful with dizziness, hearing loss may show no improvement. A hearing aid may be very helpful. 
 
In cases which do not respond there are alternatives.  Patients with no usable hearing in the involved ear have the option of surgical destruction of the ear (labyrinthectomy) with excellent results.  If hearing is good, this is not an option.  The balance nerve can be cut (vestibular neurectomy) sparing the hearing nerve.  Middle ear injection of Gentamycin can be done in the office.  This medication destroys the balance nerve endings in the inner ear sparing the hearing nerve endings.  Surgery to improve function of the part of the inner ear involved in fluid regulation (the endolymphatic sac) is available.  All these treatments involve some discomfort and risk of hearing damage.  The best choice for a particular individual is often difficult.  A good rule of thumb is to be conservative in managing Meniere's disease, especially early on, and when the possibility of future involvement of other ear is uncertain. 

A new therapy for Meniere's Disease shows a great deal of promise.  It is a nondestructive nonsurgical device called the Meniett which requires the insertion of a myringotomy tube, and is available by prescription.  For information go to http://www.meniett.com.

For more information on Meniere's disease visit the National Institute on Deafness and Other Communication Disorders: NIDCD website.