Three stages
Ménière’s disease generally progresses through three
distinct stages of symptoms. However you can’t predict the timing
of stages and severity of symptoms at each stage for a particular individual
- these vary from person to person. This can make diagnosis of Ménière’s
disease complex.
Symptom-free periods (remission) may also occur naturally. As well as
making diagnosis difficult, all these variations make it difficult to
judge the effectiveness of treatments in controlling symptoms.
Stage 1
Vertigo is a form of dizziness
where your surroundings appear to ‘spin’. Vertigo
is usually the main symptom at this stage and may be accompanied by severe
vomiting. Vertigo attacks can last for hours - sometimes
days - tending to occur in clusters. Balance returns after each attack
but you can feel ‘washed out’ for days after.
Often, by the time you present for diagnostic tests, the ear has returned
to normal. But because life style and dietary changes (eg reduced salt
and caffeine intake) can lessen the long-term effects of Ménière’s
disease, it is important to get an accurate diagnosis as soon as possible.
Patient history is one of the most important factors in making a diagnosis
of Ménière’s disease. However, often the vertigo is
so distressing that you can fail to notice other symptoms such as changes
in hearing or tinnitus (ringing noise in the ear). You need an astute
doctor asking the right questions!
Around half the people who are affected with this stage of Ménière’s
may experience a remission of symptoms - that is, symptoms will ‘disappear’.
This remission may last weeks, months or many years. Remission can occur
even though you have experienced several attacks.
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Stage
2
It is easier to diagnose Ménière’s disease during
this stage, as the symptoms are ‘classical’:
- Attacks of vertigo continue.
- Tinnitus increases with attacks
of vertigo and becomes continuous.
- The feeling of pressure or fullness
in the ear may be worse before and during a vertigo attack.
- Hearing fluctuates, but never
returns to normal levels.
Periods of remission (ie. no symptoms occur) between vertigo attacks
can vary from a few weeks to several years during this stage. About 50%
of patients will progress to the next stage of the disease.
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Stage
3
This stage is often referred to as “burnt out Ménière’s”.
Your hearing loss may be severe at all frequency levels
to the point where it is difficult to recognise speech. There is no longer
fluctuation in hearing levels as the hair cells of the inner ear have
been destroyed. Although you may feel that your hearing is useless, it
is rare for an ear to become completely deaf.
The tinnitus (noise in the ears) remains but may seem less of a problem
because you've got used to it.
Attacks of vertigo (dizziness) occur much less frequently and eventually
cease. Usually you no longer vomit and the nausea and dizziness is mild.
Unfortunately when the ear has lost 50% of its balancing function, a persistent
feeling of unsteadiness may replace attacks of vertigo. This lack of balance
is more noticeable in the dark or where you cannot use your vision to
orient yourself.
A few people may experience 'drop attacks' (Tumarkin’s
crises) in which balance is lost for a few seconds and you fall to the
ground - a particular concern for the elderly. Drop attacks occur without
warning and with minimal vertigo. It’s unusual for these attacks
to continue happening for longer than one year.
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Last reviewed Dec 2006
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