Meniere disease is a chronic balance disorder disease that occurs with disruption of fluid balance in the inner ear, progressing with dizziness (vertigo), hearing loss, ringing in the ear, and feeling of fullness. The cause of Meniere disease is increased fluid pressure in the inner ear. This situation affects both balance and hearing.

Meniere disease affects 3-5 out of every 1000 people worldwide and generally starts between ages 40-60. Although seen slightly more frequently in women, it can appear in both genders.

This disease developing in attacks can seriously reduce the person’s quality of life and work performance. The disease can be controlled with early diagnosis and appropriate treatment. Early recognition and appropriate treatment of this disease is critically important to slow disease progression and protect patients’ quality of life. People experiencing recurrent dizziness, ear ringing, or hearing decrease should apply to a neurology or ear-nose-throat specialist without delay.

What is Meniere Disease?

Meniere disease is a chronic balance and hearing disorder that occurs as a result of endolymphatic system fluid increase (hydrops) in the inner ear. This situation causes four basic symptoms specific to the disease by affecting both hearing and balance functions of the inner ear: vertigo (dizziness), ear ringing (tinnitus), pressure or fullness sensation, and hearing loss.

The disease was first described in 1861 by French physician Prosper Menière.

Causes and Mechanism of Meniere Disease

At the foundation of Meniere disease is a pathological process called endolymphatic hydrops. Increase of endolymph fluid in the membranous labyrinth located in the inner ear leads to expansion of Reissner’s membrane and functional disorder in the balance organ in the inner ear. This fluid accumulation creates pressure increase in the cochlea and vestibular structures, affecting both hearing and balance systems.

Although the pathophysiology of the disease cannot be fully explained, endolymphatic sac dysfunction, fluid absorption problems, autoimmune processes, and vascular factors are among possible causes. Meniere disease generally starts in one ear; however, in 30-40% of patients it can spread to both ears over time.

Course and Effects of Meniere Disease

Meniere disease is a disease progressing with attacks. Outside of attack periods, patients generally can continue their normal daily lives. However, the chronic nature of the disease and unpredictable attacks can significantly reduce quality of life.

The course of the disease varies from person to person. While spontaneous improvement is seen over time in some patients, progressive hearing loss and balance problems can develop in others.

What are the Causes of Meniere Disease?

The exact cause of Meniere disease is not fully known. However, research shows that more than one factor plays a role in disease development. Therefore, Meniere disease is accepted as a multifactorial disease.

1. Genetic Factors

Genetic predisposition is one of the most important causes of Meniere disease. More frequent occurrence of the disease in people with family history supports genetic transmission possibility. In some studies, relationship with HLA type II alleles has been detected. Additionally, concordance rate up to 60% in identical twins strengthens the genetic role.

2. Autoimmune Mechanisms

The immune system attacking inner ear tissues can cause Meniere disease. Autoantibodies disrupt fluid balance by creating damage in endolymphatic sac epithelium. Especially antibodies developing against proteins such as type II collagen, beta-tectorin, and cochlin can be effective in this process. In some Meniere patients, association with other autoimmune diseases such as autoimmune thyroiditis, rheumatoid arthritis is observed.

3. Viral Infections

Some viruses such as Herpes simplex virus, cytomegalovirus, and Epstein-Barr virus can remain silent (latent) in the inner ear for a long time. Reactivation of these viruses can lead to inflammation in inner ear tissue. Therefore, Meniere-like symptoms can develop after viral labyrinthitis.

4. Endolymphatic Sac and Canal Pathologies

Structural disorders of the endolymphatic sac and canal system in the inner ear negatively affect fluid absorption. Anatomic variations, hypoplasia (insufficient development), or obstruction can lead to fluid accumulation. Additionally, diseases such as temporal bone trauma, chronic middle ear inflammation (otitis media), or otosclerosis can also affect this system.

5. Vascular Factors

Disruptions in inner ear blood circulation, especially microvascular ischemia or vasospasm, can cause endolymphatic pressure changes. More frequent occurrence of Meniere disease in people with migraine disease suggests that vascular mechanisms may be related to the disease.

6. Hormonal Factors

Hormonal changes, especially in women, can affect Meniere attacks. Increase in attack frequency during menstrual cycle, pregnancy, and menopause periods supports hormonal effects. Presence of estrogen receptors in the inner ear is an important finding explaining this relationship.

7. Environmental and Lifestyle Factors

Daily life habits can trigger Meniere disease. Excessive salt consumption, caffeine, alcohol and smoking, stress, sleep irregularities, and barometric pressure changes can provoke attacks. Additionally, ototoxic drugs (for example, some antibiotics or diuretics) can facilitate disease development by damaging inner ear structure.

What are the Symptoms of Meniere Disease?

Symptoms of Meniere disease consist of four basic findings specific to the disease and are of great importance for diagnosis. These symptoms generally appear in attacks; between attacks, the person generally feels normal. The severity and frequency of symptoms can vary from person to person.

1. Vertigo (Rotational Dizziness)

Vertigo is the most characteristic and disturbing symptom of Meniere disease. This severe dizziness that starts suddenly comes with the feeling that the surroundings are spinning and can completely immobilize the patient.

Vertigo attacks generally last between 20 minutes and 12 hours and pass spontaneously. During attack, nausea, vomiting, cold sweating, and imbalance are frequently seen.

Patients generally have to lie down; even the slightest head movement can increase complaints. During vertigo attack, involuntary eye tremor (nystagmus) can be seen and this is a finding helpful for diagnosis.

In some patients, warning symptoms indicating approaching attack (for example, fullness in ear, increase in ringing, or decrease in hearing) can appear. In advanced stages of the disease, vertigo attacks can become rare, but hearing loss can become permanent.

2. Tinnitus (Ear Ringing)

Tinnitus, meaning buzzing or ringing in the ear, is the second most common symptom of Meniere disease.

Patients generally describe this sound as “buzzing“, “motor sound“, or “ocean wave sound“. Ringing is generally low frequency and monotone in tone.

Tinnitus can intensify before attacks and can be a harbinger of approaching vertigo attack. Although it decreases after attack, it often doesn’t completely disappear and can become chronic.

It becomes more pronounced in quiet environments; in the long term it can lead to problems such as sleep disorder, concentration difficulty, and anxiety. Therefore, management of tinnitus is an important part of Meniere disease treatment.

3. Hearing Loss

Hearing loss is one of the most important symptoms of Meniere disease and determines disease course.

Initially it shows fluctuating course: hearing level decreases during attacks, can partially improve afterward. Generally low frequency sounds are affected more.

In early stages, hearing loss can be temporary; however, as disease progresses, it becomes permanent and progressive.

Over time, difficulty understanding conversations increases, especially in noisy environments. Therefore, regular audiometry controls are critically important in Meniere disease follow-up.

4. Psychological Symptoms: Anxiety, Stress, and Depression

Meniere disease is a disease that is challenging not only physically but also mentally. Unpredictability of attacks can lead to continuous anxiety in patients.

Many patients withdraw from social activities, avoid traveling, and quality of life decreases due to “not knowing when the next attack will come.”

Stress is an important factor both triggering attacks and worsening disease process.

Depression is frequently seen especially in people with long-standing disease. Hearing loss, isolation, and uncontrolled attacks can increase depressive symptoms.

Therefore, psychological support should not be neglected in holistic treatment of Meniere disease.

How is Meniere Disease Diagnosed?

Meniere disease diagnosis is made by evaluating patient complaints, clinical findings, and audiovestibular test results together. Currently, American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) criteria are used for diagnosis.

1. Clinical Diagnostic Criteria

The following criteria must be met for Meniere disease diagnosis:

• At least two spontaneous vertigo attacks (each should last 20 minutes–12 hours)
• Sensorineural hearing loss at low or medium frequencies shown by audiometry
• Tinnitus (ear ringing) or aural fullness (feeling of fullness in ear) in the same ear
• Exclusion of other diseases that could cause these findings

These criteria are important both for confirming diagnosis and distinguishing from other vestibular diseases.

2. Anamnesis (Patient History) and Clinical Evaluation

The first step of the diagnostic process is taking detailed patient history.

• Duration, frequency, triggering factors of vertigo attacks
• Whether hearing loss is temporary or permanent
• Character of tinnitus and its relationship with attacks
• Presence of feeling of fullness in ear

Additionally, family history, past ear diseases, medications used, and accompanying systemic diseases are also evaluated. This information helps understand the multifactorial nature of the disease.

3. Physical Examination and Balance Tests

Ear, nose, throat, and neurological examination is performed.

• Balance status is evaluated with Romberg, Fukuda stepping, and tandem walking tests.
• Weber and Rinne tests are used to determine the type of hearing loss.
  Central nervous system pathologies are excluded with these tests.

4. Audiometric (Hearing) Evaluation

Pure tone audiometry is the gold standard in Meniere disease diagnosis.

Specific to the disease:

• Sensorineural hearing loss at low and medium frequencies is seen.
• Hearing loss has fluctuating character; can improve between attacks.

Additionally, tympanometry and acoustic reflex tests are applied to exclude middle ear diseases.

5. Vestibular (Balance) Tests

Vestibular function tests support diagnosis in Meniere disease:

• Caloric test: Evaluates lateral semicircular canal function; asymmetric response or canal paresis can be detected.
• Video-nystagmography (VNG): Determines spontaneous or positional nystagmus.
• Vestibular evoked myogenic potentials (VEMP): Shows function of otolith organs.

6. Imaging Methods

Magnetic Resonance Imaging (MRI) is used to exclude other diseases that could cause similar symptoms.

• Retrocochlear pathologies such as acoustic neuroma, meningioma are evaluated with temporal bone MRI.
• Gadolinium contrast-enhanced MRI can directly show endolymphatic hydrops in some centers; however, this method is not in routine use.

7. Differential Diagnosis

Meniere disease can be confused with many vestibular diseases.

Main conditions that should be excluded in differential diagnosis are:

• Vestibular migraine
• Acoustic neuroma
• Otosclerosis
• Vestibular neuritis
• Perilymph fistula

Vestibular migraine requires careful evaluation because it is clinically very similar to Meniere disease. Vestibular migraine and Meniere disease are both diseases progressing with dizziness (vertigo) attacks. However, their underlying mechanisms, accompanying symptoms, and effects on hearing are different from each other.

• Vestibular migraine is a central nervous system (brain-origin) disorder.
• Meniere disease occurs as a result of fluid imbalance in inner ear (endolymphatic hydrops).
• The two diseases can also be seen together; this situation can make diagnosis and treatment more complex.
• For definitive diagnosis, joint evaluation by neurology and ear nose throat specialists is the most correct approach.

How is Meniere Disease Treated?

Meniere disease treatment requires a multidisciplinary approach due to the disease’s chronic course and multifactorial causes. The aim of treatment is:

• To control vertigo attacks,
• To slow hearing loss progression,
• To increase quality of life.

Treatment is planned under two main headings:

1. Acute attack treatment
2. Long-term (preventive) treatment

1. Diet and Lifestyle Adjustments

Diet changes form the foundation of Meniere disease treatment.

• Daily salt (sodium) intake should be reduced below 2 grams.
• Salty, processed foods (pickles, brine, ready-made sauces) should be limited.
• Caffeine, alcohol, and smoking consumption should be reduced, quit if possible.
• Adequate fluid intake, regular sleep, and stress management support attack control.

These lifestyle changes can significantly decrease attack frequency by reducing endolymphatic fluid accumulation.

2. Medical (Medication) Treatment

a. Attack Period Treatment

During acute vertigo attack, the aim is to relieve the patient and stabilize the balance system.

Medications used:

• Antihistamines (for example, dimenhydrinate)
• Anticholinergics
• Benzodiazepines (for example, diazepam)

These medications reduce dizziness, nausea, and vomiting.

b. Long-Term Treatment

To reduce attack frequency and regulate fluid balance:

• Diuretics (hydrochlorothiazide, furosemide)
• Betahistine: Increases blood flow in inner ear, facilitates vestibular compensation.

When these treatments are used regularly and in controlled manner, they can slow disease progression.

3. Vestibular Rehabilitation

Balance exercises and vestibular rehabilitation are an important part of treatment in Meniere disease.

• Gaze stabilization and balance exercises enable the brain to reorganize vestibular signals.
• Exercise programs performed with physiotherapist accompaniment help patients regain balance and reduce fear of dizziness.

4. Psychological Support and Stress Management

Meniere disease can lead to psychological problems such as anxiety, stress, and depression due to unpredictable attacks.

• Cognitive behavioral therapy (CBT)
• Stress reduction techniques
• Support groups

These approaches strengthen the patient’s ability to manage attacks and increase quality of life.

5. Intratympanic (Inside Middle Ear) Treatments

In cases not responding to medications, intratympanic injection is an effective option.

• Corticosteroid injection: Provides anti-inflammatory effect in inner ear, regulates balance.
• Gentamicin injection: Suppresses vestibular activity, but is applied carefully due to hearing loss risk.

This method reduces systemic side effects with local effect.

6. Surgical Treatment

Surgical options are evaluated in patients who cannot be controlled despite medical treatment.

Main methods:

• Endolymphatic sac decompression: Reduces pressure, hearing can be preserved.
• Vestibular neurectomy: Vertigo control is provided by cutting balance nerve.
• Labyrinthectomy: Applied to completely eliminate vertigo in patients whose hearing is completely lost.

In surgical decision, patient’s age, hearing status, and attack frequency are considered.

7. Follow-up and Long-Term Management

Meniere disease requires long-term follow-up.

• Hearing loss should be regularly monitored with audiometry.
• Response to treatment is evaluated and medication or lifestyle adjustments are made when necessary.
• In the long term, patient education and psychosocial support increase treatment success.

Frequently Asked Questions About Meniere Disease

1. What is Meniere Disease and What is Its Difference from Other Dizziness Types?

Meniere disease is a chronic inner ear disease that develops as a result of disruption of endolymphatic fluid balance in the inner ear. This condition manifests with recurrent vertigo (dizziness) attacks, hearing loss, ear ringing (tinnitus), and feeling of fullness in ear.

The most important feature distinguishing Meniere disease from other dizziness types is long duration of attacks and accompaniment of hearing loss.

Comparison of Meniere Disease with Other Dizziness Types:

Dizziness Type	Attack Feature	Hearing Involvement	Typical Feature
Meniere Disease	Vertigo attacks lasting 20 minutes – 12 hours	Sensorineural hearing loss at low frequencies	Fullness in ear + tinnitus + vertigo
BPPV (Benign Paroxysmal Positional Vertigo)	Short-duration vertigo when head position changes (seconds – minutes)	None	Triggered by head movement
Vestibular Neuritis	Single, long-lasting severe vertigo attack	None	Viral origin; hearing is normal
Vestibular Migraine	Vertigo lasting minutes – hours; often accompanied by headache	None or minimal	Migraine history present

Meniere disease, unlike these dizziness types, progresses with recurrent attacks and hearing loss is progressive. Additionally, vertigo attacks are generally not related to position change.

Basic Findings Required for Diagnosis

For Meniere disease diagnosis to be made, four main symptoms must be present together:

1. Vertigo (rotational dizziness)
2. Tinnitus (ringing or buzzing in ear)
3. Hearing loss (especially at low frequencies)
4. Feeling of fullness in ear (aural fullness)

In addition to these findings, sensorineural hearing loss at low-medium frequencies should be shown in audiometry test.

2. At What Age Does Meniere Disease Appear?

Meniere disease is rarely seen in childhood, but can start from the 20s. The highest occurrence frequency is in the 40-60 age range.

In this age range, hormonal changes, stress, weakening in vascular structure, and immune system differences in the body can prepare the ground for disease appearance.

In some people, additional factors such as migraine, autoimmune diseases, or viral infections can cause the disease to start at earlier age.

3. Is Meniere Disease Hereditary?

Research shows that genetic predisposition plays an important role in Meniere disease.

• The risk of disease occurrence in first-degree relatives of a person with Meniere disease is 10-15 times higher compared to population average.
• Concordance rate up to 60% in monozygotic (identical) twins supports the effect of genetic factors.
• Especially HLA type II alleles and some gene variants can increase disease risk by leading to disruption in mechanisms regulating inner ear fluid balance.

However, Meniere disease is not a hereditary disease transmitted with a single gene mutation.

It is a multifactorial disease that occurs as a result of interaction of environmental factors (for example stress, eating habits, viral infections) together with genetic predisposition.

4. How Should Nutrition Be in Meniere Disease? Which Foods Should Be Avoided?

Nutrition plan is of great importance in Meniere disease treatment.

The main aim of diet is to prevent attacks by preserving fluid balance in inner ear and lighten disease course.

Therefore, lifestyle changes such as salt restriction, caffeine and alcohol limitation are an inseparable part of treatment.

Salt (Sodium) Restriction

The most important diet rule in Meniere disease is to reduce daily salt intake.

• Daily sodium amount should be below 2 grams (approximately 1 teaspoon salt).
• Excessive salt triggers dizziness attacks by increasing endolymphatic fluid accumulation in inner ear.
• Ready-made and processed foods (pickles, brine, canned foods, ready-made soup, chips, fast food products) should therefore be limited as much as possible.
• At home, meals should be prepared with little salt and fresh.

Caffeine, Alcohol, and Nicotine

• Caffeine (coffee, tea, energy drinks, chocolate) can affect inner ear blood flow and increase ear ringing (tinnitus).
• Alcohol can increase attack risk by suppressing balance system.
• Smoking (nicotine) disrupts inner ear circulation by leading to vascular constriction.
  Therefore, complete cessation or minimization of these substances is recommended.

Sugar and Refined Carbohydrates

Sudden blood sugar fluctuations can negatively affect inner ear fluid balance.

• White flour foods, sweets, sugary drinks should be limited.
• Whole grains, vegetables, and fiber-rich foods should be preferred.

Plenty of Water and Regular Meals

• Adequate water consumption (1.5-2 liters per day) preserves fluid balance in body.
• Regular meal hours keep blood pressure and electrolyte balance stable.
  This can especially help prevent sudden vertigo attacks.

Additives and Trigger Foods

Some patients notice that certain additives trigger attacks.

• Monosodium glutamate (MSG), aspartame, and some food dyes can increase symptoms in sensitive people.
  Therefore, reading labels and staying away from processed foods is important.
  Since there can be person-specific differences, keeping a nutrition diary makes it easier to understand which foods are related to attacks.

Recommended Nutrition Approach

• Apply a low-salt diet focused on fresh vegetables and fruits.
• Prefer caffeine-free beverages.
• Stay away from alcohol, processed food, and excess sugar.
• Take care to consume similar amounts of water and salt every day (avoid sudden changes).

5. Is Meniere Disease Progressive? Can Hearing Be Completely Lost?

Meniere disease is chronic, meaning long-term and progressive disease. However, disease course can differ in each patient.

While it remains limited to periodic attacks in some patients, hearing loss can progress over time in others.

In early stages of the disease, hearing loss shows fluctuating feature.

Hearing can partially improve after vertigo attacks, but each new attack has potential to leave permanent damage in inner ear.

Over time, this damage can accumulate, causing progressive hearing loss.

In Meniere disease patients:

• In approximately 60-80%, disease remains in one ear,
• In 20-40%, it affects both ears over time

Hearing loss initially is mild or moderate and especially affects low frequency sounds.

With disease progression, loss can become irreversible.

In rare cases, especially in patients with long-standing disease, total hearing loss can develop.

Interestingly, in final stages of disease, vertigo attacks generally decrease.

The reason for this is complete loss of vestibular function in damaged inner ear and brain re-establishing balance through compensation.

6. When Do Meniere Disease Attacks Come? How Can I Prevent Them?

Meniere disease attacks are generally unpredictable, which is one of the most challenging aspects of the disease.

Attacks can appear at intervals varying between weeks, months, or even years.

In some patients, vertigo attacks can be experienced several times per week.

When and How Do Meniere Attacks Start?

Although exact time of attacks cannot be predicted beforehand, many patients can notice warning symptoms before attack.

These symptoms can be harbingers of approaching attack:

• Increase in feeling of fullness in ear
• Intensification of tinnitus (ear ringing)
• Temporary decrease in hearing
• Imbalance or slight spinning sensation in head

Patients who notice these preliminary symptoms can reduce attack severity by taking necessary precautions early.

What Triggers Meniere Disease Attacks?

Attacks in Meniere disease are generally related to lifestyle and environmental factors.

Common attack triggers are:

• Excessive salt intake
• Caffeine, alcohol, and nicotine
• Stress and anxiety
• Sleep deprivation and fatigue
• Air pressure changes (storm, humidity, altitude)
• Hormonal fluctuations (menstrual cycle, menopause)
• High-volume environments

These triggers can differ from person to person, so keeping an individual attack diary is beneficial.

What Can Be Done to Prevent Meniere Attacks?

Although it’s not always possible to completely prevent Meniere attacks, it’s possible to reduce frequency and severity with lifestyle adjustments.

Nutrition and Lifestyle Recommendations

• Apply low-salt diet (less than 2 grams sodium per day).
• Avoid caffeine, alcohol, and cigarettes.
• Drink plenty of water and don’t skip meals.
• Limit processed foods and sugary foods.

Stress and Sleep Management

• Sleep regularly, go to bed and wake up at same time every day.
• Include relaxing activities such as meditation, yoga, breathing exercises in routine.
• If needed, get psychological support for anxiety and stress management.

Regular Medication Use

• Betahistine and diuretic medications used with doctor recommendation can reduce attack frequency by balancing inner ear pressure.
• Not interrupting medication treatment and going to regular doctor controls provides long-term control.

Why Is Psychological Support Important?

Meniere disease can create anxiety and fear due to unpredictable attacks.

This situation can cause a stress-attack cycle, further aggravating the disease.

Therefore, getting psychological support is beneficial not only mentally but also physiologically.