Stages of Meniere’s disease

Three stages

Meniere’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 Meniere’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 Meniere’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 Meniere’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 Meniere’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.

Stage 2

It is easier to diagnose Meniere’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.

Stage 3

This stage is often referred to as “burnt out Meniere’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.