Meniere’s Disease (MD) is a debilitating illness with a lot of unknowns about it’s true nature. This misunderstanding has led to a lot of MD patients getting ineffective or excessively damaging treatments on patients that are desperate for relief. It’s also an illness that tends to be misdiagnosed by a lot of clinicians unless you have substantial experience working with dizzy patients.
So how do you know if you have a true Meniere’s Disease versus other vestibular disorders, and what are your options once you do know that you have Meniere’s?
Meniere’s Disease vs Other Vestibular Disorders
Meniere’s Disease is part of a spectrum of disorders called vestibular disorders. Vestibular disorders consist of any illness that affects the inner ear system that controls your sense of balance and equilibrium.
Examples of vestibular disorders include:
- Benign Paroxysmal Positional Vertigo (BPPV)
- Vestibular neuritis
- Vestibular migraine
- Mal de Debarquement
- Central vestibulopathy (stroke or brain injury)
Diagnosing vestibular disorders can be challenging because there’re so many things that can cause dizziness.
Meniere’s Disease is defined by vertigo that comes out of nowhere (episodic), hearing loss, ringing in the ears (tinnitus), and a clogged feeling in the ears (aural fullness).
When we compare Meniere’s to other disorders, the closest diagnosis has to be vestibular migraine because of it’s episodic levels of vertigo. It’s also challenging because there is a large overlap in patients with Meniere’s having a history of migraine headaches [Source]
The defining characteristic with Meniere’s Disease when you compare it to other vestibular disorders is hearing loss and auditory symptoms, specifically the feelings of fullness in the ears.
If you have vertigo and dizziness, but you don’t have hearing loss with auditory symptoms, then you do not have Meniere’s Disease.
Difficulty Treating Meniere’s Disease
Another key component with Meneire’s Disease is the fact that it is notoriously difficult to treat. While other vestibular disorders like BPPV and vestibular neuritis can be treated successfully with Epley Maneuvers and vestibular rehabilitation, these procedures are not beneficial for patients with Meniere’s.
A big reason is that Meniere’s Disease can come in the form of flare ups. So while patients with Meniere’s can get some benefit from doing vestibular and balance training between flare ups, they will often regress hard when a flare up occurs again.
The timing and frequency of flare ups is unique to each patient. Some may experience flare ups on a weekly basis while others can go months between episodes. Each flare up does tend to worsen auditory symptoms which is even more distressing.
Medications like Beta Histadine may provide some benefit between flare ups but generally doesn’t affect hearing. Recommendations for a low sodium diet appear to provide some relief in reducing episodes, but compliance to the diet is poor.
Furthermore, there aren’t any good therapies that affect the auditory symptoms. The constant feeling of fullness in the ear and the roaring tinnitus persist and get worse. Currently, only steroid or gentamyicn injections have been used for some patients, but outcomes are hit or miss.
Patients who are at their wits end may get surgical decompression of the vestibular organ, or choose to cut nerve in the ear in hopes to get relief. This comes with the price of hearing and vestibular loss for the affected ear.
Anecdotal evidence from chiropractors focusing on the upper neck have given many with Meniere’s hope for some improvement. Dozens of case reports show that adjustments to the upper cervical spine have given patients relief in both the vestibular and auditory symptoms related to Meniere’s Disease.
Dr. Michael Burcon out of Michigan began a clinic specifically for treating patients with Meniere’s Disease and published outcomes on 300 patients with the disorder. [Source]
Over the course of 6 years, he reported a large improvement across 300 patients with most improvements occurring by 6 weeks. He also noted that many MD patients could identify a whiplash trauma to the neck about 15 years before symptom onset suggesting the cervical injury may play a role in people with a genetic disposition to Meniere’s.
How the neck influences Meniere’s is currently unknown. There’s suspicion that the upper cervical shift may distort function of the autonomic nervous system causing dysfunctional flow of blood and cerebrospinal fluid. The strong contributions of the upper cervical spine to the vestibular system is also a mechanism for how the neck can influence the dizziness and vertigo symptoms.
While these cases are anecdotal, the improvements that Meniere’s patients have with cervical focused chiropractors is compelling enough and safe enough for patients with MD to explore given the fact that other options are less safe and provide marginal benefit.