Ménière’s disease is caused primarily by abnormal fluid buildup in the inner ear, specifically in a part called the endolymphatic sac and duct. This fluid, known as endolymph, normally helps with hearing and balance by cushioning and transmitting sound and motion signals. When too much endolymph accumulates—a condition called endolymphatic hydrops—it disrupts the delicate balance of pressure and function within the inner ear. This disruption leads to the hallmark symptoms of Ménière’s disease: episodes of vertigo (a spinning sensation), fluctuating hearing loss, tinnitus (ringing or buzzing in the ear), and a feeling of fullness or pressure in the affected ear.
The exact reason why this fluid imbalance occurs is not fully understood, but several factors are believed to contribute. These include problems with fluid drainage or absorption in the inner ear, possibly due to anatomical abnormalities, viral infections, autoimmune responses, or genetic predispositions. In some cases, trauma to the head or ear, allergies, or vascular issues affecting blood flow to the ear may play a role. The excess fluid increases pressure inside the inner ear, which interferes with the normal functioning of sensory cells responsible for hearing and balance.
During an episode, the increased pressure can cause sudden vertigo attacks lasting from minutes to hours, accompanied by worsening hearing and tinnitus. Over time, repeated episodes can cause permanent damage to the inner ear structures, leading to progressive and often irreversible hearing loss. The hearing loss usually starts in low frequencies and may worsen gradually, sometimes resulting in significant impairment in one ear. The tinnitus can vary in intensity and may become a persistent, bothersome symptom.
Ménière’s disease tends to affect one ear initially, but in some cases, both ears can be involved. The frequency and severity of attacks vary widely among individuals, with some experiencing frequent, severe episodes and others having long periods of remission. The unpredictable nature of the disease can cause anxiety and impact quality of life.
In summary, Ménière’s disease arises from a complex interplay of factors that cause abnormal fluid accumulation in the inner ear, disrupting its normal function and leading to the characteristic symptoms of vertigo, hearing loss, tinnitus, and ear fullness. While the precise cause remains unclear, the fluid imbalance and resulting pressure changes are central to the disease process.
