In Brief

• It is caused by increased fluid pressure in the inner ear and comes in attacks.

• A typical attack brings severe vertigo lasting more than 20 minutes but less than 24 hours, with ringing, fullness and hearing loss in the affected ear.

• It is diagnosed from a detailed history together with hearing and balance tests; MRI is used when needed.

• It is a treatable condition: lifestyle and diet changes, medication and, if necessary, surgery are used.

⚠️ Emergency: If dizziness comes with slurred speech, a drooping face, weakness in an arm or leg, double vision or being unable to walk, do not wait – call 112 (emergency).

―――――――――――

What Is Ménière's Disease?

Ménière's disease can be defined as a set of recurrent symptoms caused by increased pressure of endolymph, the fluid of the inner ear (endolymphatic hydrops). The symptoms are recurrent, severe dizziness (vertigo), loud ringing or roaring in the affected ear (tinnitus), recurrent fullness and/or pain in the ear, and episodes of hearing loss. It affects about 190 in every 100,000 people.

​

What Are the Symptoms of Ménière's Disease?

​

​

 

 

 

 

 

 

 

 

 

 

 

 

Vertigo: This is the symptom that troubles patients most, and it occurs in attacks. Vertigo usually lasts longer than 20 minutes and ends within 24 hours. Many patients go to the emergency department during these acute attacks. Vertigo is often accompanied by nausea and vomiting. After an attack, most patients feel exhausted (post-attack fatigue) and sleepy. During an attack there may also be cardiovascular signs such as palpitations, high blood pressure and a fast heart rate.

​

Tinnitus (ringing, roaring): This is the second most troublesome symptom of Ménière's disease. Tinnitus is often constant (day and night) but becomes louder during or before a vertigo attack. In the early stages of the disease the tinnitus is low-pitched (a deep, roaring sound); in later stages, as all frequencies become involved, it spreads toward higher-pitched sounds.

Ear pain and/or fullness: This occurs in almost all patients with Ménière's disease. It begins before or together with a vertigo attack and is felt as fullness in the affected ear or as pain around the ear that sometimes spreads to the neck.

​

Hearing loss: This is one of the most important symptoms of Ménière's disease. Hearing loss appears before or during a vertigo attack, and after the attack hearing returns to near its previous level. However, each attack causes a loss of the hair cells responsible for hearing in the inner ear, gradually leaving permanent (sensorineural) hearing loss. The degree of hearing loss varies depending on when the disease began, how often and how long the attacks are, and the presence of other conditions.

​

Other Findings: Depending on when the disease began, how often and how long the attacks are, and other accompanying conditions, additional health problems can develop.

The most important of these are anxiety and depression. In many patients, the emotional strain caused by vertigo leads to depression. For this reason, accompanying psychological problems should also be treated alongside the main symptoms.

In addition, because the autonomic nervous system is affected, gastrointestinal and cardiovascular complaints are common. Many patients with Ménière's disease have gastroesophageal reflux and ulcers, so chest pain and heartburn are common. Many patients also have palpitations, a fast heart rate (tachycardia) and high blood pressure.

​

How Is Ménière's Disease Diagnosed?

​

Diagnostic guidelines were first published in 1972 by the American Academy of Otolaryngology Committee on Hearing and Equilibrium (AAO-HNS CHE), and the current criteria were revised in 2015 by the Classification Committee of the Bárány Society. The criteria rely largely on the patient's history and are divided into two categories:

1. Definite Ménière's disease:

• Two or more episodes of vertigo, each lasting 20 minutes to 12 hours.

• Low- to medium-frequency sensorineural hearing loss documented by a hearing test before, during or after one of the vertigo episodes.

• Fluctuating ear symptoms in the affected ear [hearing, tinnitus, fullness and/or pain].

• Not better explained by another vestibular (balance) disorder.

2. Probable Ménière's disease:

• Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours.

• Fluctuating ear symptoms in the affected ear [hearing, tinnitus, fullness and/or pain].

• Not better explained by another vestibular (balance) disorder.

 

In addition to a detailed history, we use hearing and balance tests (VNG, VEMP, vHIT) to diagnose Ménière's disease. When necessary, 3 Tesla MRI can be used both to rule out central nervous system disease and to support the diagnosis.

 

How Is Ménière's Disease Treated?

Ménière's disease is treatable. Depending on when the disease began, how often and how long the vertigo attacks are, the degree of hearing loss, the severity of tinnitus, and the patient's occupation and psychological state, one or more of the following treatment options are used.

​

​

 

 

 

 

 

 

 

 

 

 

 

 

 

Lifestyle and Diet Recommendations:

• Limit salt intake (less than 1.5 g per day)

• Do not smoke

• Limit products containing theophylline and caffeine (tea, coffee, cola, chocolate, etc.)

• Limit solid fats and fried foods

• Avoid weight gain; overweight patients should start a diet

• Avoid a sedentary lifestyle (walking and outdoor activities are beneficial)

• Avoid strenuous exercise

 

Medication:

Many medications are used in the treatment of Ménière's disease. The most commonly used today are:

• Betahistine

• Acetazolamide

• Dimenhydrinate

• Cinnarizine

 

Betahistine: First used in Europe in the 1970s, it has since been used by more than 100 million patients and is today the most commonly used medication for Ménière's disease. It works through several mechanisms:

• Increasing blood flow in the inner ear (via the stria vascularis)

• Increasing vascular permeability in the endolymphatic sac (the sac that regulates inner-ear fluid)

• Through its H1 agonist effect, increasing the release of mucin, surfactant and interleukins, with an immune-regulating effect in the inner ear

• Through its H1 agonist effect, contributing to ion transport in the endolymphatic sac

• Speeding up the absorption of endolymph

• Regulating the vestibular nuclei (in the brainstem), particularly through its H3 antagonist effect

Betahistine is often chosen as the first treatment for Ménière's disease. It is effective in controlling vertigo attacks but has less effect on tinnitus and no effect on hearing loss.

Acetazolamide: Through its diuretic effect it lowers endolymph pressure and can be used to stop vertigo attacks. Long-term use can cause potassium loss, an early sign of which is numbness and tingling. Patients taking acetazolamide should eat potassium-rich foods (such as bananas and potatoes). Acetazolamide is helpful for tinnitus, but because it causes potassium loss, care is needed with long-term use.

 

Medications Given Into the Ear (Intratympanic Treatments):

Medications injected into the middle ear are now commonly used to treat Ménière's disease. The most commonly used are:

• Steroids (corticosteroids)

• Gentamicin

These treatments are given under local anesthesia. They are highly effective and control the disease successfully.

​

         Steroid injections:

These are usually given as repeated injections. Although the number of injections and the technique vary between clinics, they are very successful in controlling the disease. They are used based on the idea that Ménière's disease is related to immune system disorders, and their success supports this view. They do not harm hearing and successfully control vertigo attacks.

       Gentamicin:

Gentamicin is an aminoglycoside antibiotic. It is more than 90% successful as a long-term treatment for Ménière's disease and can control vertigo permanently. Until 2015 it was given in multiple doses, like steroids, but today a single (low) dose is used. Studies show no difference in vertigo control between single-dose and multiple-dose treatment. With multiple doses, hearing worsened in about 30% of treated ears, whereas with a single dose this rate has fallen to about 15%.

 

 Surgical Treatments:

Because intratympanic treatments control vertigo successfully, surgery for Ménière's disease is performed less often than in the past. The most common operations are:

• Endolymphatic sac surgery

• Vestibular neurectomy

 

     Endolymphatic sac surgery: This is performed in patients whose disease cannot be controlled with medication or intratympanic steroids, who have good hearing, or who have Ménière's disease in both ears. Its success rate varies between studies and is around 50%.

      Vestibular neurectomy: Together with intratympanic gentamicin, this is the most effective treatment for Ménière's disease. In patients whose vertigo is not controlled after gentamicin treatment, it stops vertigo attacks in more than 95% of cases. As with gentamicin, there is a risk of hearing loss.

 

An app for recording attacks: You can use the Dizziness Diary app to record your attacks, eye videos and test results on your phone and share them with your doctor at your visit.

 

Research by Assoc. Prof. Mehmet Sürmeli on This Topic

The following studies were published in international peer-reviewed journals.

• Evaluating vertebrobasilar insufficiency and Ménière's disease: insights from cervical VEMP and video head impulse test. Sürmeli M, Sürmeli R, Yalçın D, et al. Ideggyogy Sz. 2024. PubMed →

• Thyroid hormone deficiency induces endolymphatic hydrops: neurological and histopathological evidence from an experimental rat model. Meral Kantarcı G, Şahin Önder S, Gelenli Dolanbay E, Sürmeli M, et al. Front Neurol. 2026. PubMed →

 

Record your attacks and changes in hearing and ear fullness: Dizziness Diary app → It is free, your records are stored only on your phone, and it prepares a clear summary you can share with your doctor at your visit.

 

Detailed information and diagnostic criteria for physicians: vestibology.com › Ménière’s disease · About balance tests: Balance Tests