Meniere’s disease


Meniere’s disease (MD) is a combination of hearing loss, tinnitus and fullness in the affected ear, together with dizziness caused by an abnormal fluctuation in the levels of fluid (endolymph) in the inner ear.

The initial pattern is usually a sensation of fullness, tinnitus and diminished hearing in the affected ear, followed by a severe attack of dizziness accompanied by vomiting and sometimes diarrhoea.The four symptoms, however, may not always follow this pattern.

MD is a very disruptive condition affecting the individual’s social, family and working life. The unpredictability of the symptoms of dizziness and hearing fluctuation generates an overall sense of insecurity, leading individuals to withdrawal from social contact.

The hearing loss may be one of the first symptoms but it is usually ignored until the first attack of dizziness. The tinnitus is usually considered more troublesome than the hearing loss but the dizziness is the most disturbing of the symptoms. The damage to the cochlea also makes the ear more sensitive and intolerant to loud sounds, a condition known as recruitment.

Hearing loss is an invisible handicap and generally underestimated, as such it is usually overlooked and misunderstood in MD.

In the first stage of MD the hearing loss affects only the low tones (bass) when the levels of endolymph are high in the cochlea. The hearing returns to normal after an attack of dizziness.

In the second stage the hearing continues to fluctuate but it never returns to its normal levels. Over a period of days or even several times in a single day, the hearing may have different degrees of acuity.

In the third stage (burn out) the hearing is very impaired and distorted but more stable - it may still fluctuate slightly but with a more linear pattern - the tinnitus and recruitment are very troublesome.

The inability to hear at a consistent level as it happens in MD makes it difficult to accept and understand the hearing loss. Some attribute the hearing difficulties to external factors such as background noise, “mumbling speakers”, poor environmental acoustics, and bad reception of telephone, TV or radio amongst other things. Many also believe that the tinnitus is responsible for their hearing difficulties. The reality is that the excessive levels of endolymph fluid damage the cochlea, causing a hearing loss. The hearing handicap is worse if both ears are affected but even one impaired ear can be very disruptive.

Hearing loss is a major source of stress, anxiety and depression. Most people do not realize the impact of a hearing loss in family, social and work life.

Hearing Aids & Meniere's Disease

There is still a misconception that hearing aids are of little, if any, help for those with MD. Hearing losses caused by MD are certainly very difficult to be dealt with, but not impossible as some may believe. With the advent of digital sound processing incorporated into hearing aid technology, the possibilities of enhancing hearing in MD have also significantly improved. Modern hearing aids amplify the sounds to match the hearing loss very precisely and also reduce loud sounds to comfortable levels.

When successfully fitted an individual with MD can expect that the hearing aid will minimize the impact of the hearing loss making every-day sounds clearer, reduce the discomfort of recruitment by compressing uncomfortably loud sounds to a more tolerable volume, and reduce the tinnitus perception to a less distressing level.

When considering a hearing aid the first step is to visit a suitably qualified audiologist with experience in Meniere’s disease. There are more than 300 hearing aids from more than 10 manufacturers available in Australia. They come in different sizes, shapes, colours and prices. It should however, be kept in mind that hearing aids are medical devices and not fashion items. The quality of the hearing aid is extremely important for those with MD. The natural hearing is typically distorted due to the cochlear damage and needs to be compensated by the best possible amplified sound quality.

The existence of a fluctuating hearing loss needs to be established based on a series of hearing tests performed at different times of the day over a period of time. Only then can a suitable hearing aid be selected. All hearing aids need to be fine tuned for an individual’s hearing loss and even more so in MD. Successfully fitting a hearing aid to someone with MD is an ongoing process requiring several sessions with the audiologist.

A hearing aid may sound perfect when it is first tuned for someone with MD but next day the hearing may drop or improve and the hearing aid will sound too weak or too loud or simply distorted. Hearing fluctuation means that sometimes the hearing may be better for the trebles and other times it may be better for the bass sounds. The hearing aid needs to be selected based on the pattern of the hearing fluctuation. A hearing aid with a volume control may be sufficient if there is very little or no fluctuation. A multiple memory hearing aid may be selected if the pattern of fluctuation can be established and predicted.

If the hearing fluctuation is non-linear and unpredictable, as it usually is in the second stage of MD, only a “self- programmable” hearing aid system will be of help. Such a system is still in its experimental phases and is only available from Healthy Hearing & Balance Care in Bondi Junction as part of a research project in conjunction with Macquarie University.

As of April 2004 more than 20 participants with Meniere’s disease have tried this “self-programmable” hearing aid system. At the end of the trial some required the system long term while others only needed a multi-memory hearing aid or simply a good quality digital aid with a volume control.

Here are some of the hearing aid study participants testimonials:

“I am now able to go back to work as I am in control of my hearing”
“I am back to my social life”
“I can sit at a dinner table and have a conversation with my family”
“Background noise is not as much of a problem”
“I can schedule meetings with the confidence that my hearing won’t let me down"

Useful links

Meniere's Support Group
http://www.menieresnsw.org.au/

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©2007, Celene McNeill