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Ear & hearing
Ménière’s disease
A disorder affecting inner ear homeostasis, manifested by episodic vertigo lasting hours, fluctuating hearing loss, tinnitus and aural fullness. Rarely sudden drop attacks can develop, but when present are debilitating.
Clinical content by the surgeons of Sydney ENT Clinic · Updated October 2026
The reported prevalence varies widely but probably sits around 190 per 100,000. It is almost twice as common in women than men, and most commonly presents in the age range from 20-60 years. Whilst usually affecting only one ear, approximately 15% of cases will involve both ears. It usually arises de-novo, but can occasionally develop following severe infections or trauma
Diagnosis however is often not easy, as the classic symptoms are not always present and other conditions can manifest in similar ways. Episodes of vertigo can be triggered in many ways, most commonly stress (physical or emotional) and salt in the diet. Less commonly allergies, food triggers, menstrual fluctuations amongst others can play a role.
In addition to a careful history, documentation of sensorineural (nerve) hearing loss is essential to help confirm the presence of Meniere’s Disease. The commonest cause of episodic vertigo is BPPV (benign positional paroxysmal vertigo), but this is characterised by brief head positional vertigo. The major differential diagnosis is vestibular migraine (or MAV, migraine associated vertigo) which essentially cannot directly cause hearing loss. It is not uncommon, however to have coexisting Meniere’s Disease and migrainous vertigo.
There is no definitive test to confirm the diagnosis. An electrophysiologic test called the EChOG has been used in this regard, and if abnormal, can be suggestive but in general terms is not usually helpful. According to the AAO-HNS guidelines a diagnosis of definite Meniere’s Disease is only made at autopsy. Audiology and selective balance function tests can assist in assessing severity of disease and ability to compensate to the symptoms.
Initially one of the first steps to be taken is to rule out the presence of intracranial pathology such as an Acoustic Neuroma (Vestibular Schwannoma), which requires a MRI scan of the brain.
Traditionally different phases of the disease have been described, but rarely does the disease follow a predictable pattern. In general terms though over time many people suffer from a progressive hearing loss, and eventually recurrent vertiginous attacks fade. Like the permanent nerve damage to the hearing nerve, permanent damage to the vestibular system also occurs. This can lead to permanent imbalance, dizziness, and what is often described as a ‘cotton wool’ feeling in the head. These symptoms are more pronounced if other components of the balance system are impaired. These include eyesight, joint function (including the neck), and cardiovascular health.
The overwhelming goal of long term management is to minimise the number of vertigo attacks and maintain hearing and balance function, and in the acute phase to truncate the severity of an attack.
Tested at Kogarah on the day
Hearing tests with Precision Hearing are available in Suite 5 at the time of your appointment, and CT or MRI of the ear can be arranged at Lumus or Castlereagh Imaging within a few hundred metres of the clinic.
Frequently asked questions
How is Ménière’s disease diagnosed?
Ménière’s disease is uncommon and can be difficult to diagnose, because there is no single test for it. The diagnosis rests on the pattern of symptoms: episodes of true, severe, spinning vertigo lasting from twenty minutes to several hours; a fluctuating sensorineural (nerve) hearing loss, which in the early stages typically affects the low frequencies; and a sense of fullness or pressure in the affected ear, often with tinnitus. Hearing tests over time, examination and usually an MRI (to exclude other causes of one-sided symptoms) make up the assessment.
Does Ménière’s disease go away?
The goal of treatment is control rather than cure, and in a high proportion of people the vertigo attacks can be well controlled with conservative measures — lifestyle and dietary changes and medication. The condition often burns itself out over years, but the hearing loss it leaves behind is usually permanent, which is why managing the hearing is as important as managing the vertigo.
What triggers a Ménière’s attack and can diet help?
Almost any form of stress on the body can trigger an attack: emotional stress and anxiety, poor sleep and fatigue, dehydration, and other illness — a cold or upper respiratory infection, or an unrelated medical condition that is not well controlled. Diet matters for some people: a high-salt diet, alcohol and sometimes caffeine can provoke attacks, and a low-salt diet with steady fluid intake is a standard first step. Keeping a diary of attacks helps to identify your own triggers.
What treatments are available when medication does not control the vertigo?
Treatment is stepwise. After lifestyle and dietary changes and medication (including diuretics and betahistine), the next step is injection of steroid through the ear drum into the middle ear (intratympanic steroid), which is done in the rooms. If the vertigo remains disabling, the options become ablative — treatments that deliberately switch off the balance function of that ear: intratympanic gentamicin injections, endolymphatic sac surgery, and in the most severe cases a labyrinthectomy. Throughout, management of the hearing loss is essential; this ranges from hearing aids to, in advanced disease, cochlear implantation.
Will Ménière’s disease affect both ears?
In most people it affects one ear, but it becomes bilateral in roughly 20 per cent over time. That possibility is one of the reasons the destructive (ablative) treatments are reserved for severe cases, and why the hearing in both ears is monitored.
Who treats this at Kogarah
Complex otology, cochlear implantation and lateral skull base: Dr Sean Flanagan, Darlinghurst.
For GPs
Send the referral directly to the specialist’s rooms. If the right surgeon isn’t obvious, send it to any of us and we will place it.
Referral information