CAUTION: It is not possible to self-diagnose
Meniere's Disease. Meniere's Disease is *not* defined by its
symptoms. There are many disorders that have the same symptoms
as Meniere's Disease. A differential diagnosis with diagnostic
tests is required. For a diagnosis, you *must* see a licensed
and qualified medical professional. See
our Diagnosis Page.
"Meniere's Disease" is
the name given to certain symptoms of no known cause and with no known
cure.
"Meniere" refers to
French physician Prosper Meniere, who first described the symptoms
that we now call Meniere's Disease in 1861.
"Meniere's Disease"
is a term commonly used in the U.S., U.K., Canada, Australia, and most
other English-speaking countries.
"Morbus Meniere" ("MM")
is German for Meniere's Disease.
"Morbus" means
"disease." Hence, "Morbus Meniere" means "disease of Meniere," or
"Meniere's Disease." For unknown reasons, "MM" is frequently
used by patients on the Internet. However, "MM" is not generally
used within the English-speaking medical community. If you use
the term "MM" when talking to your doctors, they will likely not know
what you mean and they will think that you are ill-informed.
"Maladie de Meniere" is
French for "Meniere's Disease." "Maladie" means "disease."
Hence, "Maladie de Meniere" means "disease of Meniere," or "Meniere's
Disease."
"Meniere's Syndrome."
A "syndrome" is a
collection of symptoms. Therefore, "Meniere's Syndrome" refers to
the collection of symptoms that comprise "Meniere's Disease."
"Meniere's Syndrome" is perhaps the better term than "Meniere's
Disease," because Meniere's Disease is defined by (1) its symptoms (2)
together with the fact that no other cause can be determined, and (3)
not by any direct test. We believe that the term "Meniere's
Disease" is actually a misnomer, although it is the most commonly used
term.
Definition.
In general.
There are many different definitions of Meniere's Disease.
Here is our definition:
"Classic"
(typical) Meniere's Disease is the term given to the condition having
the following four symptoms, after thorough testing for all other
diseases and disorders having the same symptoms are negative (see our
Diagnosis Page):
Episodic,
fluctuating hearing loss.
Episodic,
fluctuating rotational vertigo (a form of dizziness).
Episodic,
fluctuating tinnitus (a sound heard when there is no sound).
Episodic,
fluctuating aural fullness (a sense of air pressure in the middle ear,
as if descending in an airplane; however, it is *not* actual air
pressure in the middle ear; Meniere's Disease does not affect the
middle ear).
Here is the most
commonly-used authoritative definition (in the U.S.):
"Classic"
(typical) Meniere's Disease is characterized by four classic symptoms.
Episodic,
fluctuating rotational vertigo -- a specific form of vertigo in
which there is a sense that the world is spinning around you.
The rotational vertigo usually results in the consequences of nausea
and vomiting.
However, Meniere's
Disease patients generally do not experience nausea and vomiting in
the absence of rotational vertigo, and nausea and vomiting are not
symptoms of Meniere's Disease. The intensity may be very mild or
may be extreme, characterized as "attacks,"
or even "drop attacks" during which
the patient involuntarily drops to the ground. The duration may
be minutes, hours, days, or even longer. Some patients always
have a sense of instability, which they label and distinguish from
"vertigo" as "dizziness" or "dizzies," because the world doesn't seem
to be spinning around them, although they are still experiencing
low-level vertigo.
Episodic, fluctuating hearing loss. Loss of hearing, usually (but not
always) in one ear. The extent of hearing loss increases over time.
Episodic, fluctuating tinnitus. Sound, usually (but not always) in one ear, without an
external cause. The sound varies in type from person to person. It may
be a whining, a roaring, or other sound; sometimes there are multiple
sounds. The intensity may fluctuate between zero and sleep-depriving.
The pitch may be high or low. Tinnitus may exist even in those who are
otherwise totally deaf.
Note: There is a
form of tinnitus that is *not* associated with Meniere's Disease,
called "pulsatile tinnitus." In this form of tinnitus, one
hears a sound like one's own heartbeat (because it is).
Pulsatile tinnitus may be caused by an identifiable vascular problem,
and may be curable.
Episodic, fluctuating sense of fullness.
A "plugged ear" or "stopped ear"
sensation, usually (but not always) in one ear, varying in intensity.
The sense of fullness (a feeling like, but not actually, air pressure
in the middle ear) for many is like descending from a mountain and
being unable to "clear" or "equalize" the pressure. (However,
Meniere's Disease does not affect the middle ear.)
Some patients
experience fluctuating aural fullness that can become acute, sometimes
even to the point of ear pain (although ear pain is unrecognized as a
symptom in the authoritative literature); other patients experience
lesser degrees of fluctuating aural fullness.
No other symptoms.
There are only four
symptoms of Meniere's Disease: (1) episodic, fluctuating
rotational vertigo, (2) episodic, fluctuating hearing loss, (3)
episodic, fluctuating tinnitus, and (4) episodic, fluctuating sense of
fullness.
There are no other
symptoms of Meniere's Disease. The fact that some patients may
experience any other symptom does not make that symptom a symptom of
Meniere's Disease.
Reminder: Nausea and
vomiting are not symptoms of Meniere's Disease. Nausea and
vomiting may or may not be a consequence of the Meniere's Disease
symptom of episodic, fluctuating rotational vertigo, but nausea and
vomiting are not symptoms of Meniere's Disease.
Episodic.
Meniere's Disease
symptoms are "episodic," meaning that patients experience "episodes,"
meaning times when their symptoms are worse than they are at other
times. Severe episodes are often described as "attacks."
Fluctuating.
Meniere's Disease symptoms
"fluctuate," meaning that they vary in intensity and duration. When one is
having an episode, one's symptoms may be greater or lesser than during
any previous episode.
Example:
One's hearing may be fairly usable and an hour later, one's hearing
may be severely impaired. Yet a few hours later, one's hearing
may improve somewhat. However, over time, one's best hearing
will decline. The hearing of some patients will decline faster,
and the hearing of other patients will decline more slowly.
Classic "Meniere's
triad." Although
modern
definitions of Meniere's Disease include the fourth symptom of
aural fullness, some older authorities may refer to a "Meniere's
triad" of three symptoms (rotational vertigo, hearing loss, and
tinnitus), overlooking the now-recognized symptom of aural fullness.
Nonetheless, aural fullness has always been, spoken or unspoken, an
accompanying symptom of Meniere's Disease.
Atypical Meniere's
Disease -- three symptoms, two types.
The "a" in
"atypical" means "not." "Atypical" means "not typical."
It is possible to have three of the four
classic symptoms and yet be diagnosed with an atypical form of
Meniere's Disease. There are two types of
"atypical" Meniere's Disease.
Cochlear hydrops -- no
rotational vertigo.
Some
Meniere's Disease patients experience hearing loss, fullness, and
tinnitus with no rotational vertigo at all, a condition sometimes
described as "cochlear
hydrops" or "cochlear Meniere's Disease." Some
physicians don't consider "cochlear hydrops" to be Meniere's disease
at all; other physicians consider cochlear hydrops to be a form of
Meniere's disease. Some physicians believe that cochlear hydrops will
always progress to Meniere's Disease with rotational vertigo; others
don't.
Some
Meniere's Disease patients experience rotational vertigo, fullness,
and tinnitus with no hearing loss at all, a condition sometimes
described as "vestibular
hydrops" or "vestibular Meniere's Disease." Some
physicians don't consider vestibular hydrops to be Meniere's Disease
at all; other physicians consider vestibular hydrops to be a form of
Meniere's Disease. Some physicians believe that vestibular hydrops
will always progress to Meniere's Disease with hearing loss; others
don't.
In general.
Severe episodes of the symptoms of Meniere's Disease are often
described by patients as "attacks."
Rotational vertigo
(vertiginous) attacks.
Some,
perhaps most, but not all, patients experience (with or without prior
warning in the form of increased tinnitus, fullness, and hearing loss)
sudden attacks of rotational vertigo (with or without attacks of
tinnitus, hearing loss, and fullness), believed by some to be caused
by leakage of excess endolymph (a potassium-rich fluid in the inner
ear) into perilymph (another fluid in the inner ear, but sodium-rich)
and/or into the labyrinth where it interferes with tiny hairs that
feed into nerve endings that control balance.
"Drop" attacks.
Acute rotational
vertigo (acute vertiginous attacks). Some patients get such
acute attacks of rotational vertigo that they suddenly drop to the
ground as if they have been struck by a sledgehammer. Patients are
totally helpless as the world seems to spin around them, and they
vomit severely from the resulting nausea. The attacks can last minutes
or hours. After the attacks finally subside, patients may sleep for
hours and sometimes for days. Some patients get such drop attacks
frequently, others experience them every year or two, and others not
at all. Most Meniere's patients call these acute attacks "drop
attacks." Some patients can sense a drop attack approaching
through a sudden increase in tinnitus and/or fullness, and/or a sudden
hearing loss, but other patients get no warning. Some patients
who have experienced drop attacks without warning fear driving because
they worry about the consequences should they experience a drop attack
while driving.
Otolithic crisis of
Tumarkin (otolithic crises of Tumarkin). An "otolithic
crisis of Tumarkin" is a sudden drop to the ground -- without any
Meniere's symptoms -- followed by an immediate recovery by merely
standing up again.
Disagreement over the
use of the term "drop attack." The term "drop attacks" is sometimes debated.
Some
would say a "drop attack" is properly used only to describe a "Tumarkin's
crisis" or "otolithic crisis of Tumarkin," which is not accompanied by
symptoms of Meniere's Disease. Others would use the term to
describe acute rotational vertigo (acute vertiginious attack) due to
Meniere's Disease. We believe that this debate is rather
pointless. We would say that anytime one falls to the ground
from whatever disorder, one could properly describe the event as a
"drop attack." Certainly Meniere's Disease patients who fall to
the ground with the world spinning around them, usually vomiting, and
usually immobilized by the dizziness and nausea, would describe the
event as a "drop attack."
Some definitions of
"drop attack."
One definition. According to this definition, an
Otolithic Crisis of Tumarkin would not involve rotational vertigo,
nausea, or vomiting.
"Drop Attacks," by Timothy C. Hain, M.D. This article suggests that the term "drop attack" has
a more general application (beyond Meniere's patients) and does not
involve Meniere's symptoms.
Dr. Troost's
description. This description is more consistent with
the notion that a "drop attack" equates with an "acute attack" and
also equates with an "otolithic crisis of Tumarkin."
Patients
may experience mild rotational vertigo that they call "dizzies."
They may consider consider this "dizziness" to be different from acute
rotational vertigo, but it is probably mild rotational vertigo.
At times there may be no dizziness. At times there may be a feeling
that "I am about to be dizzy." There may be mild continuous
dizziness for hours, days, or longer.
Nystagmus
(involuntary eye movements). During acute attacks, nystagmus may
be observed. (Nystagmus may also be observed during
electronystagmography (ENG) (caloric stimulation
test). See our diagnosis page.)
Lermoyez syndrome.
Temporary improved hearing and tinnitus may occur around the time
of an acute attack.This phenomenon is known as "Lermoyez
syndrome."
While
"classic" Meniere's Disease affects only one ear, some patients "go
bi," meaning bilateral; they experience symptoms in both ears. How
many patients go bi? That's a widely debated subject; estimates range
from 10-15% (Merck
Manual) to at least as high as 20-60% (University of
Kansas).
Fluctuating
symptoms. Meniere's Disease
symptoms typically fluctuate, meaning that they are more severe at
some times, and less severe (or even not occurring) at others; this
phenomenon may or may not occur in concert. In other words, one
symptom may fluctuate toward the more severe end of the scale, while
another symptom fluctuates toward the less severe end of the scale.
Age of onset.
Onset can occur at any age, from children to the very elderly. The
"typical" age of onset of Meniere's Disease is variously said to be
30-50, but the many exceptions seem to challenge the rule.
Children with
Meniere's Disease (juvenile Meniere's Disease, pediatric Meniere's
Disease). Although most people first observe symptoms of
Meniere's Disease in "middle age," some people first observe symptoms
as children, and sometimes as very young children. Symptoms,
diagnosis, treatment, and prognosis are the same for children as for
adults. We have no further information specific to children.
Sensitivity to
sound -- recruitment and hyperacusis.
Interestingly, and
seemingly contradictorily, some Meniere's Disease patients, at the
same time that they are losing their hearing, develop a
hypersensitivity to sound. "Recruitment" is a hypersensitivity
to loud sounds, and "hyperacusis" is a hypersensitivity to all sounds;
according to the
Hyperacusis Site. It can be maddening for both patients
and others, when a patient has at the same time both hearing loss and
yet also a hypersensitivity to sounds.
Specialized ear plugs.
There are many kinds of earplugs besides those found in the drug
store. With sensitivity to sound, one's objective would be to diminish
sound, or certain sounds, rather than block them completely or muffle
them. "Musician's" earplugs are designed to do that to a certain
extent, and there may be many more types of earplugs that might be
helpful to you, perhaps custom-designed.
Depression is common among patients with Meniere's Disease, especially
when treatment is not effective. Depression is common among all
patients with any chronic (lasting) and/or progressive diseases.
Meniere's Disease can be a life-altering condition, preventing
patients from engaging in the workplace, home responsibility, and
leisure activities in which they were once active. Patients can
feel undeserved guilt, helplessness, and isolation. Depression
is treatable, provided that treatment is sought.
Anxiety is common
among Meniere's Disease patients, particularly because one never knows
(a) when an episode (attack) of symptoms will occur, and (b) what the
future will bring, and when. Anxiety can be treated.
Fatigue
can be a symptom of depression (see above) or just of the stress in
battling this disease.
Headache.
Many
people in the general population experience headaches. Not
surprisingly, many Meniere's Disease sufferers experience headaches.
However, headaches are not regarded as Meniere's Disease symptoms.
Headaches can be consequences of Meniere's Disease symptoms. In other
words, Meniere's Disease does not cause headaches directly, but you
may get headaches from Meniere's Disease symptoms of spinning and
tinnitus, etc. However, if you have Meniere's Disease and get
headaches, this may be a distinction without a difference. Having
Meniere's Disease doesn't stop you from having other ailments as well.
There are a number of studies that support an undefined association of
some sort between migraine and Meniere's.
Minor LB.
Meniere's Disease and Migraine. Arch Otolaryngol Head Neck Surg.
2005 May;131(5):460. No abstract available. PMID: 15897429 [PubMed -
in process]
Boyev KP.
Meniere's disease or migraine? The clinical significance of
fluctuating hearing loss with vertigo. Arch Otolaryngol Head
Neck Surg. 2005 May;131(5):457-9. No abstract available. PMID:
15897428 [PubMed - in process]
Some, perhaps many, but not all, patients
also report, anecdotally, forgetfulness, memory loss,
feelings of confusion,
disorientation, and/or
sensory overload. Many patients with chronic (long-term)
medical problems experience some form of this condition. "Brain
fog" is a term used by Meniere's Disease patients. Patients with
other medical problems use other terms for the same
condition. There is no authoritative source that
documents "brain fog," and brain fog is not a symptom of Meniere's
Disease.
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