Ménière’s Disease: Symptoms, Diagnosis and Treatment

Quick answer

Episodic vertigo with ear symptoms; manage triggers and attacks

Ménière’s disease usually affects one ear and is thought to involve excess fluid pressure (endolymphatic hydrops) in the inner ear. Attacks of vertigo lasting 20 minutes to 12 hours come with tinnitus, ear fullness and low-frequency hearing loss. Treatment includes a lower-salt diet, limiting caffeine and alcohol, managing stress, medicines for attacks and, if needed, diuretics, intratympanic injections or surgery. Hearing loss often progresses over time, so hearing support matters. Diagnosis needs a hearing test and exclusion of other causes.

Important. Sudden hearing loss, vertigo with double vision, difficulty speaking, facial weakness or limb weakness, severe headache or a head injury needs emergency care, because it can be a stroke or another urgent condition.

What is Ménière’s disease?

The inner ear contains the cochlea (hearing) and the vestibular system (balance), filled with a fluid called endolymph. In Ménière’s disease, an abnormal build-up of this fluid is thought to disturb both hearing and balance, producing attacks. It typically starts between the ages of 20 and 60, affects men and women, and about 10–15% of cases eventually involve both ears. The exact cause is not known; genetic factors, autoimmune and vascular theories and migraine have been suggested.

Symptoms

Vertigo attacks: a spinning sensation lasting from 20 minutes to 12 hours, often with nausea, vomiting and sweating.
Hearing loss that fluctuates, typically affecting low frequencies at first and becoming permanent over time.
Tinnitus: roaring or buzzing, often louder before or during an attack.
Aural fullness or pressure in the affected ear.
Drop attacks (Tumarkin crises) in some people: sudden falls without loss of consciousness.
Fatigue and imbalance for hours after attacks.
Between attacks, many people feel well, at least in the early stages.

How it is diagnosed

The diagnostic criteria (from the Bárány Society and other bodies) require at least two spontaneous episodes of vertigo lasting 20 minutes to 12 hours, documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least one occasion, and fluctuating aural symptoms (hearing, tinnitus or fullness) in that ear, not better explained by another diagnosis. A hearing test (audiogram) is essential. MRI is often done to exclude other causes such as a vestibular schwannoma. Other tests include balance testing and blood tests.

Conditions that can mimic Ménière’s disease include vestibular migraine, BPPV, vestibular neuritis, autoimmune inner ear disease and stroke. See vestibular migraine and vertigo.

Diet and lifestyle

Reduce salt: a low-sodium diet (around 1,500–2,000 mg a day) is a common first step, although evidence is limited.
Limit caffeine and alcohol, which may trigger attacks in some people.
Stay hydrated and eat regular meals.
Manage stress, which is a frequent trigger; consider relaxation, exercise and CBT.
Sleep well and keep regular routines.
Stop smoking.
Keep a diary of attacks and possible triggers.

What to do during an attack

Sit or lie down in a safe place and keep your head still; focus on a fixed point.
Avoid sudden movements, bright lights and noise.
Take anti-nausea or vestibular suppressant medicine prescribed by your doctor, for a day or two at most.
Drink fluids once the nausea settles.
Do not drive or operate machinery during or soon after an attack.
After the attack, move gradually and return to activities as tolerated.

Medicines and procedures

Betahistine is widely used in Europe, although recent evidence of benefit is limited. Diuretics (thiazides) are used to reduce attacks in some people. If attacks persist despite these measures, options include intratympanic injections of corticosteroids or gentamicin into the middle ear, which can reduce vertigo (gentamicin carries a risk of hearing loss), and surgical procedures such as endolymphatic sac surgery or, rarely, vestibular neurectomy or labyrinthectomy in severe, disabling cases with poor hearing. The AAO-HNSF guideline offers detailed recommendations on these treatments.

Hearing loss and tinnitus

Hearing in the affected ear often deteriorates over years, and many people benefit from hearing aids. Tinnitus management, including sound therapy and CBT, is helpful. Periodic hearing tests help monitor the disease. See tinnitus treatment and hearing aids for tinnitus.

When to see a doctor

Repeated attacks of vertigo with ear symptoms.
Sudden hearing loss (urgent).
Vertigo with neurological symptoms (emergency).
Hearing getting worse, or a new ear affected.
Attacks that interfere with work, driving or safety.
Feeling anxious or low because of the condition.

Three common situations

Recurrent vertigo with ringing and fullness in one ear: typical of Ménière’s; arrange a hearing test and ENT assessment.

Short spinning when turning in bed, no ear symptoms: more likely BPPV.

Attacks despite a low-salt diet: discuss medication, intratympanic therapy or other options with your ENT.

Living well with Ménière’s disease

Unpredictable attacks can make people anxious about driving, work and social life. Plan ahead: tell family and colleagues what to do during an attack, keep anti-nausea medicine to hand, avoid heights or dangerous machinery when you feel unwell and use support groups and counselling. Regular exercise, balance training and stress-reduction techniques improve confidence. Hearing aids and tinnitus management improve communication and quality of life.

Key points to remember

Ménière’s disease is chronic but manageable. A careful diagnosis, a low-salt diet, avoidance of triggers, treatment for attacks, hearing support and, if needed, procedures can reduce attacks and protect quality of life. Our ENT team can assess your ears, hearing and balance.

This guide is for general information and does not replace an assessment by your own doctor or ENT specialist.

Questions about Ménière’s disease

These answers are general information and do not replace an examination or individual medical advice.

What causes Ménière’s disease?

The exact cause is unknown; excess fluid pressure in the inner ear is thought to play a part.

Is Ménière’s disease curable?

It is usually lifelong, but treatments reduce attacks and many people live well with it.

Does Ménière’s disease cause hearing loss?

Yes, hearing often fluctuates at first and may become permanent over time.

Does a low-salt diet help?

It is a common first step and helps some people, although high-quality evidence is limited.

Can I drive with Ménière’s disease?

Not during or soon after an attack; check local regulations and ask your doctor.

What is the difference between Ménière’s and BPPV?

BPPV causes brief spinning triggered by head position without ear symptoms; Ménière’s causes longer attacks with ear fullness, tinnitus and hearing loss.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.