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Besides a stoppage of drainage pathways, abnormally enlarged fluid pathways into the ear such as the vestibular aqueduct or cochlear aqueduct may also be associated with Meniere's like symptoms.
Thus, the bottom line is that in most patients with Meniere's disease in 2015, the underlying cause of Meniere's disease is unknown. Figure 3a: Audiogram (hearing test) typical of early Meniere's disease on the right side (x=left, o=right). A longer discussion of the information to be gained in testing of persons with Meniere's disease is found here. When there is sulfa allergy, one may try amiloride by itself, or ethacrinic acid (edecrin). Histamine injections (irrational treatment as histamine is broken down rapidly in the body).
What the author recommends in his practice in Chicago for medical prevention of Meniere's.
These are combined with symptomatic drugs such as meclizine, benzodiazepines, and antiemetics, to be taken during attacks. In persons with severe progressive bilateral disease, the author will generally recommend a trial of high dose steroids.
An emerging treatment that may eventually end up as a standard treatment is multiple injections of steroids into the middle ear.
The big problem with this section is separating placebo's from slightly effective treatments. There are an immense number of placebo and probable or nearly placebo treatments for Meniere's disease. The Meniett device's status at this writing (2010) seems most likely to be a slightly effective treatment.
There is a separate page on this topic, but briefly, for intractable unilateral Menieres disease cases, we often presently advise a low dose gentamicin protocol. Persons who have intractable bilateral Meniere's disease are offered a trial of steroids with a safer immunosuppressant should this be effective, a modified gentamicin protocol, and very occasionally systemic aminoglycosides to deaden both ears.
In our opinion, medical treatments, including a reasonable trial of anti-migraine drugs such as verapamil or venlafaxine, should precede use of any last resort treatment. Hearing is thought to gradually decline throughout life, with roughly 50 dB loss in 10 years. Note that it is not the overall level of sodium that is important, but whether or not it fluctuates that is important in avoiding attacks of dizziness.
Gu X, Fang ZM, Liu Y, Huang ZW, Zhang R, Chen X.Diagnostic advantages of intratympanically gadolinium contrast-enhanced magnetic resonance imaging in patients with bilateral Meniere's disease. Sato G1, Sekine K, Matsuda K, Ueeda H, Horii A, Nishiike S, Kitahara T, Uno A, Imai T, Inohara H, Takeda N.
Testing may be helpful to ascertain the extent of damage to the 8th nerve, in persons with dizziness or hearing loss. Rotatory chair testing and VHIT testing are other methods of asessing function of the 8th nerve.
Postherpetic neuralgia is common after zoster, and may be treated with anticonvulsants, pain medications, and neuralgia medications. Audiogram shows flat sensorineural hearing loss at 60 db, typical of late Meniere's disease. VEMP shows preserved responses on both sides, the left being moderately better than the right. One would think that for the first explanation, head-shaking might also be reversed (as was seen here).
A third and very recent explanation is that the enlarged endolymphatic passages in the bad ear cause a relative increase in force exerted on the cupula, and excitation.
Spells of vertigo with nausea and sometimes vomiting, lasting minutes (30 min) to hours (up to 24) followed by imbalance that may persist between attacks. Meniere’s Disease is the term used to describe endolymphatic hydrops when all of the above symptoms are present and hearing loss is in the low frequencies (specifically  a low frequency sensory neural hearing loss). Treatment should be aimed at stabilizing the inner ear to minimize the spells.  Lifestyle changes through diet and minimize stress are the most conservative forms of treatment. DISCLAIMER: The information on this website is not intended to be a substitute for professional advice, diagnosis or treatment.
Recurrent low frequency sensory hearing loss is one characteristic sign of Meniere's disease.
In our clinical practice, where we care for large numbers of Meniere's patients, the most common age of presentation is in the 6th decade.


While in the past, it was felt that plumbing problems (hydrops) in the ear were responsible for the disease, the most current opinion is that hydrops is a marker for the Meniere's disease, rather than necessarily being responsible for the symptoms. Recent evidence is against a relationship between the cochlear aqueduct and MD (Yilmazer et al, 2001). We ourselves hold this opinion, based in part on a study in which patients with Meniere's disease had a very high prevalence (about 25%) of autoimmune thyroid disease (Brenner et al, 2004). However, the evidence is against this being the main mechanism in human beings (see Kitamura et al, 1997; Nadol et al, 1995). Those who present to the doctor with more severe hearing impairments at onset, usually do worse than those who have milder hearing impairments (Sato et al, 2014). Although Ondansetron isn't as strong as phenergan or compazine, and doesn't always work, it also doesn't have much side effects either. All of the above diuretics have sulfa in them, which persons with sulfa allergies may be unable to tolerate.
Loop diuretics such as Edecrin should be used in low doses and with caution because they are ototoxic.
If there is a significant improvement in hearing, then there is an attempt to switch to Enbrel (an immunosuppressant with less side effects than steroids), with the thought that in this situation an autoimmune disorder is more probable.
There is nothing wrong with a placebo, if it provides some benefit (presumably psychological), and you can afford to do this. This treatment requires a surgical procedure (insertion of a ventilation tube) and purchase of a very expensive device (the pressure machine). Gentamicin is administered through the ear drum every month for a total of one or two administrations.
The difficulty in pregnancy is that there should be an effort to avoid medications that might cause birth defects or otherwise injure the unborn child. Vertigo spells are generally thought to persist for decades, although with a gradual decline after roughly the first decade (Huppert et al, 2010).
It is not necessary or wise to lower your salt intake to amounts barely able to sustain life.
Psychological characteristics of patients with Meniere's disease compared with patients with vertigo, tinnitus or hearing loss. In our clinical practice in Chicago, as of 2015, we had 12 cases of Ramsay Hunt in our database. The combination of peripheral type facial weakness (Bell's palsy), with pain and blistering of the ear is generally sufficient. Those with damage may benefit from vestibular rehabilitation and there is also some prognostic significance. The left side (on the right half) is much smaller than the potential from the right ear (on the left side). The left side shows a mild low-tone sensorineural hearing loss (similar to that seen in early Meniere's disease).
If an oral antiviral is used, it is better to choose one that is better absorbed such as famvir or valacyclovir. This explanation doesn't really explain spontaneous nystagmus, but it might explain asymmetric high-velocity VOR.
It is thought there are abnormal fluctuations in the fluid called endolymph, which fills the hearing and balance structures of the inner ear.  In a normal inner ear, the endolymph is maintained at a constant volume and contains specific concentrations of sodium, potassium, chloride, and other electrolytes.
Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
We think Meniere's disease should more properly be called Meniere's syndrome, but we will use the two terms as if they were the same. This probably reflects the age distribution of Meniere's in Chicago Illinois, which of course is also a function of the age of the population in Chicago. Enlarged vestibular aqueducts are one of the most commonly identified inner ear bony malformations in children with sensorineural hearing loss of unknown cause (Oh et al, 2001). On the other hand, Ruckenstein and others recently obtained a large number of autoimmune blood tests in a group of 40 patients with unilateral Meniere's disease including CBC, ANA, Anti-Sjoegren, RF, Complement, antiphospholipid antibody, western blot for heat shock protein, MHA (syphilis test), and Lyme. Rather, it seems that Meniere's disease damages both hair cells and nerve fibers in humans. Should MRI scanners become even more powerful in the future, this could be an important test.
Oddly, there is sometimes a discrepency between OAE tests and audiometry in the low-frequency SNHL of Meniere's.
Van Deelen and Huizing studied the use of diuretics in Meniere's disease in a double-blind, placebo controlled trial, and reported that it reduces vestibular complaints, but has no significant effect on hearing (1986).


Because Menieres and Migraine are very often combined, this medication's main role may be to treat the migraine associated vertigo that can be confused with or accompany Menieres disease. Of course this strategy should rationally be adjusted to the variability in hearing, as in any undertaking, one's confidence that a particular result has been obtained depends both on the size of the effect as well as the underlying variability in the effect.
However, we don't think that placebos that are billed to health care insurance providers should be supported. Bilaterality of the condition gradually increases with time, but in most the symptoms in the opposite ear are minor. This is far less than the number of cases we have of vestibular neuritis or sudden hearing loss. In this case, doses are much lower and drug can be given every 8 hours instead of every 4 hours.
It seems unlikely that it has utility in persons who have already had Herpes Zoster, as such people should already have high levels of immunity. This fluid bathes the hair (or sensory) cells of the inner ear and allows them to function normally.
It is a little older than the typical age of presentation of vestibular migraine which is in the 5th decade, much older than the reported highest prevalence age for non-vestibular migraine (about 35), and similar to the age of presentation of BPPV. The vestibular aqueduct extends from the medial wall of the vestibule to the posterior surface of the petrous temporal bone. Only elevations in the antiphospholipid antibody test were found 27% of patients, above the expected 6-9%.
Studies of humans are handicapped by the possibility that Meniere's is the final common pathway of a variety of illnesses of the ear. Potential reasons are an exitatory nystagmus, Bechterew's phenomenon (recovery nystagmus), Meniere's involving the opposite ear, and stronger vestibular responses on the side with hydrops due to hydrodynamic factors associated with hydrops.
Another new MRI approach involves injecting gadolinium through the ear drum, and then a MRI scan (Gu et al, 2014). The same cannot always be said for meclizine, lorazepam and klonazepam, phenergan or compazine. Much room for improvement in these algorithms is needed -perhaps involving daily hearing monitoring using an internet protocol.
The treatments briefly discussed below are (probably) not placebos, but they are high in cost (because they are surgical), and low in benefit (because the literature suggests low or no efficacy). Most Ramsay Hunt patients have more damage to the facial nerve than hearing, but there are occasional exceptions (Kuhweide et al, 2002). As the 7th nerve is involved in Ramsay Hunt, it should reduce contributions to the VEMP from facial nerve innervated muscles on the side of lesion. If the inner ear is not working properly, the volume and composition of the inner-ear fluid can fluctuate with changes in the body’s fluid and electrolyte levels. Most persons with enlarged vestibular aqueducts with ear disorders have hearing loss, but occasionally there is an association with vestibular problems (Shessel and Nedzelski, 1992). This technique is plausible, but we are doubtful that the diagnostic gain justifies injecting gadolinium dye into the middle ear. Kundu (2006) were unable to come to a conclusion as to efficacy as no papers published up to 2006 were adequate for meta-analysis. For this reason, it is very important to check for the posterior auricular muscle response when doing VEMP's in this situation. There may be a genetic link between enlarged vestibular aqueduct and Pendred syndrome, which is a congenital thyroid disorder. They concluded that it is unlikely that autoimmune etiologies play a significant role in their population of unilateral Meniere's (Ruckenstein, 2002). Another interpretation of their data is that they may simply not have had an appropriate marker for autoimmune involvement, as well as unilateral Meniere's may have less autoimmune cause than bilateral. Vestibular rehabilitation can be of benefit when the fluid problem is stabilized but there is a persistent dizziness, imbalance between the spells. Surgery is another option and would typically be considered a last resort when spells cannot be managed through other interventions.



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