The Four Ear Problems of Meniere's Disease

Of the four main symptoms of Meniere’s disease, probably the least bothersome to sufferers is the sensation of fullness in the ear. Called aural fullness by doctors, it has been described as a feeling of the ears being plugged up, under pressure, "swollen," or having to "pop" (such as when one goes down rapidly in an elevator, airplane, or skin diving) without being able to equalize the pressure. This sensation may come and go, be there all the time, or only occur with the other symptoms during an attack of Meniere’s. Tests used to check the pressure in the ear, such as tympanometry, cannot detect the fullness that patients feel, and treatments that are used to treat plugged ears (clearing out wax, decongestant medications, increasing pressure in the ear through the eustachian tube, or medical maneuvers such as Valsalva's or Politzer's maneuvers) do not seem to help. This feeling may be related to what is felt to be the cause of the symptoms of Meniere’s disease, endolymph hydrops.

Tinnitus is described as hearing a sound in the ear that is not coming from outside the body or as a constant "ringing in the ears." One example is hearing the sound of blood whooshing through the blood vessels of the head and neck, but this type of tinnitus can actually be heard by a doctor using special microphones. This has been called objective tinnitus. It is similar to "hearing the ocean’s roar" when holding a seashell up to the ear. The shell actually catches the bloodstream sounds and reflects them back into the ear, where the person "hears" the sound of the ocean.

The type of tinnitus in Meniere’s disease is subjective since no one else but the patient can hear the sounds. They may be continuous, ringing, buzzing, humming, whooshing, or intermittent sounds like clicks or pops. The tinnitus may be very similar to the ringing noise that many people hear temporarily after being exposed to very loud sounds (such as a power saw, jet airplane, or music at a loud rock concert). In many sufferers, the tinnitus noise may come on just before a full attack of Meniere’s and provide a warning of an impending dizzy spell. Other people may experience the tinnitus as constantly present and very annoying. It usually seems louder in quiet settings and is more easily ignored if there are other sounds around. Although it usually cannot be cured, the annoying sound may be covered up ("masked") by a special hearing aid-like device called a tinnitus masker, which plays another sound into the ear so that the ear "forgets" to listen to the tinnitus sound. Some people have found it helpful to avoid quiet places; playing background music louder than the tinnitus or listening to "white noise," like the hiss/static from a radio tuned in between stations, may help minimize the tinnitus.

The hearing loss in Meniere’s disease is actually of two different types. A temporary, severe deficit and a slowly progressive, permanent, almost complete loss that often is not related to the attacks of the disease. Early on in the course of the disease, hearing is completely normal in between attacks, but often, with time, a loss of hearing at low frequencies may start and progress to permanent deafness.

Most medications do not appear to actually help prevent or reverse hearing loss, but some of the surgical procedures may often help prevent hearing loss. Of course, standard hearing aids may help with this problem, but the changing nature of the deafness may require occasional changes in the type of aid needed. It appears that the hair cells of the organ of Corti (see figure 1) may be killed off by the high pressure in the endolymph and may not grow back, leading to the deafness of Meniere’s. During the sudden attacks of Meniere’s, when the hearing loss is bad, it may be that the hair cells are just temporarily "stunned," and hearing may return when the endolymphatic pressure returns to normal.

The most annoying and disabling symptom of Meniere’s disease is usually vertigo, or an attack of the "dizzies" that special type of dizziness where the sufferer feels that either they or the outside world is spinning around (such as the dizziness one gets if one sits in a revolving chair and is spun around for a few moments). True vertigo, which is present in Meniere’s disease, needs to be separated from the other three forms of "dizziness" that people may complain of: lightheadedness, pre-syncope, and disequilibrium. Pre-syncope is a sensation of feeling that one is going to pass out or faint; it may precede actual blackout (syncope) spells, or one may feel that the blood is rushing out of one’s head and that one is going to faint. Disequilibrium is a condition where one may be unsteady on one’s feet, have a hard time distinguishing up from down, stumble and stagger, but there is no sensation of spinning (as in vertigo). When people get "dizzy" from drinking too much alcohol, they experience disequilibrium.

Finally, there is the sensation of lightheadedness, which is more difficult to define and can be caused by many different problems. People with this may actually have any of the other three types of dizziness and just cannot describe the sensation well enough, or they may have a vague sensation that something is wrong with their head.

True vertigo attacks of Meniere’s disease may vary from a rare feeling of spinning to disabling, severe spinning sensations so strong that the person cannot stand up, distinguish up from down, or do anything for minutes to hours at a time. People often experience severe nausea and vomiting with these attacks, because their brain cannot decide whether their eyes are wrong or their inner ears are wrong about the spinning. People with severe vertigo attacks may be unable to do anything other than lie on the floor with their eyes open until the attack resolves. Some physicians call these severe attacks of disabling vertigo "otolithic crises of tumarkin," others may refer to them as "acute labyrinthine crisis," and yet others feel that these are just excessive but typical episodes of Meniere’s vertigo spells. Nevertheless, although this is probably the most severe of the Meniere’s symptoms, it is also one of the most easily treated, with many different medications, therapies, and even surgeries that can be prescribed for this problem. These treatments may vary in effectiveness from those that lessen the severity of the symptoms, those that reduce the frequency of the attacks, those that may stop early vertigo attacks, to those treatments that are intended to cure the vertigo (with special brain/inner ear surgeries).

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