Manchester Physio

» What we treat » Vestibular physiotherapy » Menieres

Meniere's disease is a vestibular condition that is episodic in nature causing dizziness, balance and hearing issues. It is a relatively rare condition but once diagnosed requires a combination of treatment elements for a successful outcome. Physiotherapy treatment is used to help with the management of Meniere's.

Above: Vestibular physiotherapy - passive resetting exercises

What is a Meniere's

Meniere's is a condition that affects the area of the inner ear that is responsible for hearing and balance. The exact cause behind the symptoms of Meniere's is not fully understood but it is thought to be a pressure change in the inner ear that causes problems.

Meniere's is relatively rare and can occur at any age although it is most prevalent after 40. There is no set cause behind its onset however there is thought to be links with allergies, autoimmune disorders, post infection and a genetic link.

What are the symptoms of Meniere's

The symptoms of Meniere's will tend to always include:

Hearing Loss- this can affect one or both ears and can be complete to a mild hearing loss. This can also be accompanied with a pressure feeling within the ear.
Tinnitus- this is a ringing, buzzing, whistling noise in the ear.
Vertigo- sensation of movement either internally or the environment around you. This can even happen when you are sitting still.

There tends to be 3 stages to Meniere's disease, early, middle and late stages.

Early Stage - this is the onset of Meniere's symptom and the severity of the symptoms can be high with frequent attacks which can last from 2-24 hours. In the early stage nausea and vomiting can be present with the vertigo and hearing problems.

Middle Stage - the symptoms tend to reduce in severity in term of the dizziness but episodes of hearing loss continue. There tends to a reduction in the frequency of attacks also in this phase.

Late Stage - episodes of symptoms really reduce and then can completely disappear. Some people will be left with balance or hearing issues but attacks of symptoms settle.

Above: Vestibular physiotherapy - passive resetting exercises

How is Meniere's diagnosed

Meniere's is diagnosed not by one specific test but a collection of signs and symptoms. The pattern of reoccurring attacks with the symptoms of hearing loss and vertigo must be present to diagnose Meniere's. The history of a complete remission between attacks is also used with diagnosis.

Your GP may complete a number of medical tests to rule out other causes behind the symptoms, such as blood test, ear examination, blood pressure check. An ENT specialist may also be consulted and additional tests more specific to the vestibular system might be use. These could include:

Balance Tests
Audiometry (hearing tests)
Vestibular function tests

Medical treatment of Meniere's

The treatment of Meniere's can be split into the medical management and physiotherapy management. The medical treatment of Meniere's mainly consists of various medications and help with the hearing loss or tinnitus. There are surgical options but these are generally only considered in extreme or prolonged cases.

Meniere's medication can be prescribed to control symptoms during an attack which can help with symptom reduction of nausea and acute vertigo. The other type of medication that may be considered would be a betahistine for prevention of attacks. The evidence base behind the use of this medication is very variable so this would be a decision between your specialist and you to see if this would be appropriate.

Hearing loss would be looked into from a hearing aid point of view and tinnitus can be treated with sound therapy or cognitive behavioural therapy.

What treatment can Manchester Physio offer for Meniere's

Manchester Physio can offer vestibular rehabilitation and various lifestyle advice for the treatment of Meniere's.

Diet advice and triggers will be discussed following the vestibular assessment and small changes to your lifestyle can make a significant impact on the frequency of attacks.

Vestibular rehabilitation involves various exercises and tasks which aim to improve balance and reprogram the brain to ignore the disorientating signals that come from the inner ear. With vestibular training you strengthen the whole vestibular system making it stronger and more capable to deal with the changing signals from the inner ear.