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Morbus Menière
Dizziness with ear symptoms always on the same side — without pressure, rushing and fluctuating hearing it is something else.
Also known as: Menière’s disease · vertigo with ear symptoms
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In Menière’s disease the dizziness comes in attacks, and it never comes alone. The combination is characteristic: violent spinning dizziness lasting twenty minutes to several hours, together with a feeling of pressure, a rushing or ringing and a fluctuating hearing loss — and always on the same side. These ear symptoms are what separate the illness from all other forms of dizziness. The cause is too much fluid in the inner ear, which disturbs the fine pressure there. Between attacks everything is often normal at first, which delays the diagnosis; over the years hearing often falls behind in steps. The confusions matter, because they are commoner than the illness itself: positional vertigo lasts seconds and comes on turning in bed, with no ear involvement. Dizziness in migraine lasts about as long as here but goes with sensitivity to light and noise, and it is altogether far commoner. A single attack lasting days without hearing loss speaks for an inflammation of the balance nerve. A diary of the attacks settles these questions faster than any examination.
Date, time, duration in minutes, which ear, whether rushing and pressure were present, what preceded it. This list answers the question of diagnosis more reliably than an examination between attacks.
A fixed point for the eyes, no driving, no stairs. The attack passes; what remains is often an exhaustion for the rest of the day — that belongs planned for.
It is not strict avoidance that works but evenness — large swings seem to trigger more than the amount itself. Together with drinking regularly and watching caffeine and alcohol.
It is commoner than Menière, often affects people with a headache history and responds to quite different measures. This distinction saves years on the wrong road.
It is the commonest cause of dizziness of all, lasts seconds and can often be resolved in one session with a simple positioning manoeuvre. That belongs checked before looking further.
The course is judged by the hearing test, not by feel. If hearing is left behind, a hearing aid makes sense earlier than most assume — also because poor hearing puts extra load on balance.
Sit up in bed first, stay sitting for 30 seconds, tense the calves a few times, then stand. If things go black, sit or lie down at once and raise the legs.
Betahistine is meant to improve blood flow in the inner ear; the studies on it come out differently. What shortens the attack itself are drugs against vertigo and nausea. The course is wilful: in many people the attacks burn out over years while hearing in the affected ear declines.
An attack lasts twenty minutes to twelve hours — shorter points to positional vertigo, longer to nerve inflammation. The diagnosis needs at least two such attacks, plus documented hearing loss in the low to middle range and ringing or a feeling of pressure. About two in a thousand people are affected. Hearing fluctuates at first and worsens over years; the vertigo becomes rarer with the years in many people.
The duration is the first distinguishing feature. Seconds on turning over in bed speak for positional vertigo, days on end for an inflammation of the balance nerve.
Pressure, rushing and the hearing loss affect one side at first. If it changes sides or the ear is not involved at all, the diagnosis does not fit.
Before and during an attack one hears worse on the affected side, and better again afterwards. Exactly this fluctuation is typical — and often not visible on a hearing test between attacks.
Then dizziness in migraine is the likelier explanation. It is considerably commoner than Menière and treated quite differently — that is the most important confusion of all.
In an advanced course there are falls as if pushed, without loss of consciousness. They are dangerous and a reason to review the treatment — and to be honest about driving.
No value makes this diagnosis. The thyroid, though, is among the few values that can find a different explanation for dizziness and tiredness.
Anaemia causes dizziness and weakness, but not spinning vertigo with ear symptoms. Ruling it out costs little.
Low sugars and strong swings produce a dizziness that is different — not spinning but light-headedness. The distinction is worth making early.
Here it is about less, not more: a low-salt diet under about 2 g sodium a day is the classic basic measure. The evidence for it is weak, the experience with it old.
Together with salt and alcohol, what is traditionally reduced. Controlled studies are missing — it stays a personal trial over 4–8 weeks with a kept diary.
Regulates the water balance, in the inner ear too. It is the link between stress, swings in fluid and the feeling of pressure in the ear — and the reason why drinking and salting evenly works better than strict avoidance.
Steers salt and water in the kidney. Water tablets act at exactly this point — which is why they are used in this illness and why potassium and sodium belong checked alongside.
Usual is 1500–2000 mg sodium a day, about 4–5 g of salt, evenly spread. The evidence is weak but the experience of many is clear. Evenness counts for more than the lowest figure.
Both are often named as triggers. Controlled studies are lacking; a diary over 4–6 weeks with attacks and drinking habits says more than any general rule.