Ménière’s disease

Ménière’s disease is an inner-ear condition that causes attacks of spinning vertigo lasting 20 minutes to 12 hours, along with fluctuating hearing loss, tinnitus and a feeling of fullness in the affected ear. It is diagnosed and medically managed by an ear, nose and throat specialist (ENT), with a hearing test (audiogram) as a key part of the workup. Treatment focuses on reducing how often and how severely attacks happen, and may include dietary and lifestyle changes, medication, injections into the middle ear or, rarely, surgery. Vestibular rehabilitation is not a treatment for the attacks themselves, but clinical practice guidelines recommend it for people with Ménière’s who have ongoing imbalance. At McKelvie Physiotherapy in Pickering, we help with that persistent unsteadiness, and we work closely with local ENT specialists.

What is Ménière’s disease?

Ménière’s disease is a long-term condition of the inner ear. It causes attacks of spinning vertigo — usually lasting 20 minutes to 12 hours — together with symptoms in the affected ear:

• hearing loss that comes and goes, especially in the low to middle pitches
• tinnitus (ringing, roaring or buzzing)
• a feeling of fullness or pressure

It usually starts in one ear, although in some people it later affects both. Attacks are unpredictable, and over time hearing in the affected ear may become permanently reduced.

International diagnostic criteria describe definite and probable Ménière’s disease based on this pattern of vertigo attacks and ear symptoms (Lopez-Escamez et al., 2015). The diagnosis is made by an ENT, and a hearing test (audiogram) is a key part of the workup.

What causes Ménière’s disease?

The underlying cause isn’t fully understood. Ménière’s is associated with an increase in the volume of fluid (endolymph) inside the inner ear, known as endolymphatic hydrops. This is thought to disrupt the hearing and balance organs, producing the attacks and ear symptoms.

What are the symptoms of Ménière’s disease?

• Sudden attacks of spinning vertigo lasting 20 minutes to 12 hours
• Hearing loss in the affected ear that may fluctuate
• Tinnitus and a feeling of fullness or pressure in the ear, often worse around an attack
• Nausea and vomiting during attacks
• Feeling tired and wiped out after an attack
• Imbalance or unsteadiness between attacks, for some people
• Sudden “drop attacks” — falls without warning or loss of consciousness — in a small number of people, usually later in the condition

How is Ménière’s disease treated?

Your ENT diagnoses Ménière’s disease and leads its medical management. According to the AAO–HNS clinical practice guideline, treatment options include (Basura et al., 2020):

• education on dietary and lifestyle changes, such as reducing salt
• short courses of medication to ease vertigo during attacks
• longer-term medication, such as diuretics or betahistine, to try to reduce attacks
• intratympanic (middle-ear) injections of steroids or gentamicin when attacks aren’t controlled
• surgery in selected cases

Audiology and your ENT look after changes in your hearing, including hearing aids if they’re needed.

A vestibular physiotherapist has a specific, supporting role. The same guideline advises against vestibular rehabilitation for managing acute vertigo attacks — during an attack, the priority is rest and the treatment your doctor has prescribed. But it recommends vestibular rehabilitation for people with Ménière’s who have ongoing imbalance. That might be unsteadiness between attacks, or reduced balance function on one side after treatments such as gentamicin injections or surgery. Rehab uses tailored exercises to help your brain compensate and to rebuild your confidence with movement.

We can also check for other treatable causes of dizziness, such as BPPV, which can sometimes occur alongside Ménière’s disease.

1. 01

   Assess

   A detailed history and a balance and eye-movement assessment with infrared video goggles, to understand your between-attack symptoms and check for other causes such as BPPV.

2. 02

   Rebuild

   A tailored program of gaze-stability, balance and walking exercises to help your brain compensate and steady you between attacks.

3. 03

   Stay steady

   Practical strategies for daily life and confidence on your feet, with guidance on when to check back in with your ENT.

Why choose McKelvie Physiotherapy for Ménière’s disease?

• Vestibular specialists — our lead physiotherapist holds the Advanced Vestibular Physical Therapist (AVPT) certification.
• Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
• We work closely with local ENT specialists — so your rehab fits alongside your medical care.
• A thorough assessment — including checks for other treatable causes of dizziness, such as BPPV.
• One-on-one care in private rooms — your session is just you and your physiotherapist.
• Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
• Direct billing to many major insurers — and no referral needed.