Meniere’s disease

Meniere's Disease dizziness

Healthy Hearing & Balance Care is the only clinic in Australia specialised in Meniere’s disease.

If you suspect that you may have Meniere’s disease make an appointment with Dr Celene McNeill for a preliminary assessment.

The symptoms of Meniere’s disease can be successfully managed by specialised professionals so that patients can resume their normal life in spite of the diagnosis. The earlier a diagnosis is reached the easier the management.

Meniere’s disease (MD) is a disorder characterised by increased levels of endolymph in the inner ear that causes four major symptoms: attacks of vertigo which tend to occur in clusters, a fluctuating and usually progressive hearing loss, tinnitus and a sensation of aural fullness (blockage) in the affected ear.

It is estimated that approximately 50,000 people in Australia suffer from MD. The attacks of vertigo are episodic, lasting a few months followed by variable periods of remission. Eventually, these attacks peter out and the hearing becomes very poor.

The attacks of vertigo cause great distress. The sensation of spinning can last for several hours associated with nausea and vomiting.

The diagnosis of Meniere’s disease is complex due to the fluctuation of symptoms. Misdiagnosis is common because vertigo is also present in other disorders such as neuritis, labyrinthitis, vestibular migraine and BPPV which can mimic Meniere’s.

Prof William GibsonEmeritus Professor Bill Gibson has spent his career diagnosing and treating patients with Meniere’s disease and continues to be engaged in research projects searching for a cure.

Prof Gibson is now semi-retired but continues to assist patients with Meniere’s disease at our clinic by providing accurate diagnosis using trans-tympanic electrocochleography and offering advice and medical treatment.

Trans-tympanic electrocochleography is considered the gold standard test to diagnose endolymphatic hydrops which is a characteristic of Meniere’s disease. The test requires a very thin needle electrode to be placed on the cochlea’s round window niche. Prof Gibson anaesthetises the tympanic membrane and inserts the electrode using a microscope. A sound stimulus is presented in the ear canal and the cochlear potentials are recorded. The test is conducted in the clinic with the assistance of audiologist Dr Celene McNeill.

Balance Loss in Meniere’s Disease

The sequence of vertigo attacks that occur during the course of Meniere’s disease damages the balance organ.

As the disease progresses the vestibular (balance) organ becomes permanently impaired and the patient loses the ability to maintain good balance especially in the dark and in environments with high levels of visual and sound stimulation.

Neuro-physiotherapist Kathee De Lapp has a wealth of experience in the treatment of Meniere’s disease and is able to assist our patients to improve their balance function and to manage their vertigo attacks.

Hearing Loss in Meniere’s Disease

The characteristics of the hearing loss vary according to the stage of the disease as it progresses.

In the first stage of MD the hearing loss affects only the low tones (bass) when the levels of endolymph are high in the cochlea. The hearing returns to normal after an attack of dizziness.

In the second stage, the hearing continues to fluctuate but it never returns to its normal levels. Over a period of days or even several times in a single day, the hearing may have different degrees of acuity.

In the third stage (burn out) the hearing is very impaired and distorted but more stable – it may still fluctuate slightly but with a more linear pattern – the tinnitus and recruitment are very troublesome.

The inability to hear at a consistent level as it happens in MD makes it difficult to accept and understand the hearing loss. Some attribute the hearing difficulties to external factors such as background noise, “mumbling speakers”, poor environmental acoustics, and bad reception of telephone, TV or radio amongst other things. Many also believe that the tinnitus is responsible for their hearing difficulties. The reality is that the excessive levels of endolymph fluid damage the cochlea, causing a hearing loss. The hearing handicap is worse if both ears are affected but even one impaired ear can be very disruptive.

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

Hearing Aids & Meniere’s Disease

Hearing aids can definitely help patients with Meniere’s disease. Dr Celene McNeill’s PhD thesis investigated the benefits and developed a special protocol to fit hearing aids to patients with hearing fluctuation due to Meniere’s disease.

Hearing losses caused by MD are certainly very difficult to be dealt with, but not impossible as some may believe. With the advent of digital sound processing incorporated into hearing aid technology, the possibilities of enhancing hearing in MD have also significantly improved. Modern hearing aids amplify the sounds to match the hearing loss very precisely and also reduce loud sounds to comfortable levels.

When successfully fitted an individual with MD can expect that the hearing aid will minimize the impact of the hearing loss making every-day sounds clearer, reduce the discomfort of recruitment by compressing uncomfortably loud sounds to a more tolerable volume, and reduce the tinnitus perception to a less distressing level.

Prior to selecting the most suitable hearing aid, the existence of a fluctuating hearing loss needs to be established based on a series of hearing tests performed at different times of the day over a period of time. All hearing aids need to be fine-tuned for an individual’s hearing loss and even more so in MD. Successfully fitting a hearing aid to someone with MD is an ongoing process requiring several sessions with the audiologist.

A hearing aid may sound perfect when it is first tuned for someone with MD but next day the hearing may drop or improve and the hearing aid will sound too weak or too loud or simply distorted. Hearing fluctuation means that sometimes the hearing may be better for the trebles and other times it may be better for the bass sounds. The hearing aid needs to be selected based on the pattern of the hearing fluctuation. A hearing aid with a volume control may be sufficient if there is very little or no fluctuation. A multiple memory hearing aid may be selected only if the pattern of fluctuation can be established and predicted; which is rarely the case. When the hearing fluctuation is non-linear and unpredictable, as it usually is in the second stage of MD, only a “self- programmable” hearing aid system will be of help.

Dr Celene McNeill has pioneered the use of such hearing aids for patients with MD as part of her PhD studies. Hundreds of patients have been successfully fitted with self-programmable hearing aids at Healthy Hearing & Balance Care.

Feedback from Healthy Hearing & Balance Patients…

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

“I am back to my social life”

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

“Background noise is not as much of a problem”

“I can schedule meetings with the confidence that my hearing won’t let me down”

Cochlear Implants and Meniere’s Disease

In some more severe cases, the hearing loss may progress to levels that hearing aids are no longer able to assist. Our patients who reach this stage are assessed for cochlear implant candidacy and referred to one of our preferred surgeons for implantation.

Vestibular (balance) function testing is conducted at Healthy Hearing & Balance Care as part of the assessment to select the appropriate ear to receive an implant. This will minimize the possibility of vertigo and dizziness as a post-operatory complication.

Two to three weeks post- surgery the patient returns to our clinic and one of our audiologists will activate the implant and start the hearing rehabilitation process. The activation process includes objective and subjective measurements of the amount of electric current required by each electrode to stimulate the auditory cortex (part of the brain responsible for hearing). This process is known as “mapping” and the map obtained is used to program the implant for each individual profile. Several sessions with the audiologist may be required to obtain an optimum map.

Optimal hearing with a cochlear implant also requires brain rewiring and we offer a range of techniques and methods to speed up this process.

Our experience confirms scientific research showing that cochlear implants provide excellent hearing results for patients with Meniere’s disease.

However, as demonstrated by our own research (Impedance Fluctuation in Meniere’s Disease ) the cochlear implant of patients with Meniere’s disease may require more regular mapping sessions due to ongoing fluctuation in the cochlea.