Deaf and Dizzy: Is It Méniere’s?

Many people with hearing loss also have tinnitus. Some have vertigo. When all three conditions are present, the cause may be Ménière’s disease, first identified by French physician Prosper Ménière in 1861.

man-in-vertigoI emphasize “may” because Ménière’s is notoriously difficult to diagnose. There is no definitive test for Ménière’s. It’s a clinical diagnosis, based on symptoms. According to the Mayo Clinic, the criteria for Ménière’s are two episodes of vertigo, each lasting at least 20 minutes but no longer than 24 hours; hearing loss verified by a hearing test; tinnitus or a feeling of fullness in your ears. The fourth symptom, annoyingly vague, is the exclusion of other known causes of these problems.

Idiopathic Ménière’s (that is, where the cause is unknown, which is true most of the time) is frustrating to both doctor and patient. The diagnostic procedure is basically to eliminate x, y and z possibilities and then settle on Ménière’s. Ménière’s expert Steven D. Rauch, M.D., of Harvard Medical School and the Massachusetts Eye and Ear Infirmary, describes it as one of the most “vexing” clinical conditions that an ear specialist may encounter.

The problem is, when a condition is disabling, you want a diagnosis, and Ménière’s is an easy catchall. Even though the disease affects just .2 percent of the population, the Framingham Heart Study—a long-running, federally funded study on cardiovascular health—found that 1,000 times that number (2 percent) think they have Ménière’s, probably having been told that by a doctor who was as eager for a diagnosis as the patient.

It’s important when diagnosing Meniere’s to distinguish vertigo from dizziness. Vertigo is not the same as dizziness. With the latter, you feel unsteady in a stable world. You walk like a drunk. You have to hold on to things to remain standing. You can’t walk in a straight line.

With vertigo, the world seems to spin around you. The most common type is benign paroxysmal positional vertigo (BPPV), which is treatable by a doctor and with home exercises. It is an inner-ear problem but is not connected to hearing loss. My AARP colleague Candy Sagon has written about treatment for BPPV —Fixing Vertigo With a Turn of the Head..

True vertigo, which is related to hearing loss and may be caused by Ménière’s, often comes on very quickly and can last anywhere from a few moments to days or even longer. Some people suffer from it for months at a time. When you feel an attack coming on, you have to sit or lie down immediately, and you may vomit. I have this kind of vertigo. My acute attacks last for a couple of hours. I can tell that one is coming on when my eyes start to swivel to the left. I’m so drained afterward that I usually sleep for the rest of the day and night.

I don’t have Ménière’s, because I have neither tinnitus nor a fullness in the ears. I also have bilateral hearing loss, and Meniere’s usually affects only one side.

If it isn’t Ménière’s, what, then, is it? In my case it’s probably migraine-associated vertigo (MAV). MAV is equally disabling but usually is not accompanied by hearing loss. So my hearing loss and my vertigo are probably not related. Sometimes Ménière’s and MAV occur in the same patient. But because migraine is so common in the general population, MAV is about 10 to 15 times more common than Ménière’s as the cause.

If you think you might have Ménière’s, you might want to read the article “How Does the Doctor Know I Have Meniere’s?” by Timothy Hain, M.D., of the Chicago Dizziness and Hearing Center, who provides an excellent description.

Ménière’s is not curable — at least not yet — but it is treatable, especially the vertigo attacks. Although almost all sufferers gradually lose hearing in their affected ear, vertigo attacks can be controlled or eliminated in over 99 percent of cases, according to Rauch.

Changes in diet can control vertigo in about two-thirds of patients. It’s important to stay hydrated and follow a lower-sodium diet. Sometimes diuretics are prescribed. Caffeine and alcohol may exacerbate symptoms in some patients.

The Vestibular Disorders Association suggests that triggers may include foods that contain the amino acid tyramine. Examples include red wine, chicken liver, smoked meats, yogurt, chocolate, bananas, citrus fruits, figs, ripened cheeses (for example, cheddar and Brie) and nuts. These are triggers for MAV, as well.

Lifestyle factors such as stress and sleep deprivation can affect vertigo, and managing these can help. Other factors are hormonal changes, allergies and fluctuations in barometric pressure.

If all else fails, surgery can eliminate vertigo in about 5 to 10 percent of the otherwise untreatable cases.

For a first-person description of dizziness and vertigo, I recommend “Hearing Loss vs. Dizziness: If I Could Choose,” by John Brigande, posted by the Hearing Health Foundation in February.  Just reading it made me feel dizzy, though, so be forewarned.

 

This post was first published on AARP Heath on November 14.

For more on hearing loss and hearing health:

shoutingwonthelpLiving Better jpegKatherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

 

3 thoughts on “Deaf and Dizzy: Is It Méniere’s?

  1. Thank You for your knowledge about Meniure’s. We are in similar conditions. I am terrible on dates, but this is close. Got an attack in my mid-50’s (now 83). Went to House Ear Clinic as was told then about Meniures, to take some supplements and niason, along with losing my hearing over time. Always forgot about the last part until I really was out of it hearing wise. Moved to the Palm Springs area, and along with the usual mental sickness problems, rally did want to die. Went to local Audiologist who just took charge and said you are going to get an Cochlear Implant. Did it after a couple of years fighting the HMO, via appeals. Upon being what I call “hooked up” and the tears were stopping, we decided to do something to help those less fortunate. If you have the time please look up our web page and you can see we have made a positive impact. What I would like to visit with you about is starting the stories on the mental health aspect of hearing loss. Heads are buried in the sand on this issue, and we must bring it to the public’s attention. I will be starting to be bit vocal on our web page and Face Book page after the January. Thank You and have a wonderful Holiday. Fred McClory

    Like

    • Thank you for writing. What is the url of your web page?
      I’ve written quite a bit about depression and isolation with hearing loss, especially sudden hearing loss. The mental issues are sometimes complicated by worry about aging, I think.

      Like

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