Meniere’s disease (MD) is a combination of fluctuating symptoms thought to be caused by physiological disruptions in the inner ear - the organ of hearing and balance. 

Ongoing Meniere’s research is uncovering more details but genetics, allergies, viral and bacterial infections, hormonal imbalances, as well as physical trauma to the ear may be the triggers of such disruptions. Common comorbidities are migraine and auto-immune diseases.

MD mostly affects one ear only, but it is estimated that 30-50% of patients will develop the condition on the other ear over time. 

Typical symptoms are a sensation of ear fullness or pressure, tinnitus (noise in the ear), diminished hearing in the affected ear, severe attacks of spinning (vertigo) lasting for up to 10 hours accompanied by nausea and vomiting. Fluctuating hearing loss, ear fullness and tinnitus are characteristic of the condition.

A mild hearing loss affecting the low frequencies, or a blocked ear, may be the initial symptoms and the sufferer may ignore them until the first vertigo episode prompts medical intervention. 

In the initial stages the hearing can go back to normal levels during periods of remission. The attacks of vertigo also come in clusters. 

The tinnitus – a roaring, ringing, buzzing or humming in the affected ear may be perceived as more troublesome than the hearing loss. Unsuccessful attempts to unblock the ear fullness are also very frustrating but vertigo is by far the most disturbing of the symptoms. 

Misdiagnosis is common as all these symptoms may also be present in other diseases. A series of hearing tests documenting hearing fluctuation are key to the correct diagnosis.

The inability to hear at consistent levels makes it difficult to accept and understand the hearing loss. Some attribute their hearing difficulties to external factors such as the interference of background noise, “mumbling speakers”, poor environmental acoustics, and low-quality telephone, TV or radio reception. 

Others wrongly believe that tinnitus is responsible for their hearing difficulties. 

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

Hearing rehabilitation using hearing aids can be very useful in improving communication and reducing the tinnitus and ear fullness for most sufferers of MD. Hearing aids, of course, do not stop the vertigo attacks, but they help to improve the overall sense of balance by providing more accurate information of the acoustic surroundings. 

The selection of an appropriate hearing aid requires professional expertise and detailed diagnostic information of the individual’s hearing loss. The hearing fluctuation characteristics of MD adds a layer of complexity to the hearing rehabilitation process, but this can be facilitated with the guidance of an experienced audiologist. 

Self-guided hearing tests using mobile phone applications are useful in determining the pattern and extent of hearing fluctuation. Digital technology allows for self-adjustment of the hearing aids to address changes of hearing levels which ensures optimal hearing at all times.

As the disease progresses, the hearing becomes more distorted so that hearing aids are no longer suitable. At this stage, a cochlear implant (bionic ear) may be recommended as it by-passes the inner ear damage and electrically stimulates the hearing nerve providing sound perception. After a period of auditory training, hearing with the cochlear implant becomes more natural improving the ability to follow conversation even in the presence of some background noise.

Dr Celene McNeill is an audiologist with a PhD in Meniere’s disease. She is also the director of Healthy Hearing & Balance Care, a comprehensive audiology clinic in the Sydney suburb of Bondi Junction that specializes in the assessment and management of patients with Meniere’s disease.

Here are some of our patients’ testimonials:

“I am now able to go back to work as I am in control of my hearing” (MM)

“I am back to my social life” (JH)

“I can sit at a dinner table and have a conversation with my family” (WS)

“Background noise is not as much of a problem” (W)

“I can schedule meetings with the confidence that my hearing won’t let me down"(SS)

“I finally had a break from my tinnitus” (WM)