Vertigo (Morbus Menière) – symptoms
Attacks of Menière’s come in bouts and are usually repeat themselves after varying intervals. There can be an interval of several years between the respective attacks. It is also possible that only one or two episodes occur in a patient’s lifetime. The disease often begins without a complete Menière’s Triad. This means that the disorder can start with just hearing loss and tinnitus or vertigo while the classic attack of Menière’s occurs only later. In average the disorder develops during the course of one year, progressing from the first symptoms of rotatory vertigo and impaired hearing to the complete syndrome.
Vertigo
Typical of an attack of Menière’s is severe rotatory vertigo combined with nausea and vomiting. The rotatory vertigo may continue for minutes or even hours and can be so violent that the patients are unable to stand upright. The vertigo is worsened by movement but is also present when the patients remain completely immobile. The patients, therefore, try to hold their head absolutely still. Usually no disturbance of balance is experienced between the attacks.
Hearing loss
During the attack the hearing ability of the affected ear decreases, combined with a tinnitus and a sensation of pressure. Hearing dysfunctions and tinnitus may disappear again after the first attacks. After frequent episodes though the hearing loss and often also the tinnitus continue and become progressively worse. A hearing impairment can precede the complete clinical picture of Morbus Menière by years. The hearing loss usually affects low frequencies. Affected patients will noticeably often also complain of distorted hearing. In the majority of cases the extent of the hearing dysfunction has no correlation to the severity and/or frequency of the attacks. In rare cases an improvement of a pre-existing partial hearing loss can occur during an attack of Menière’s. This is then called Lermoyez Syndrom.
Tinnitus
The hearing deterioration which occurs during the attacks concurs with the onset or the increase in volume of a tinnitus. The typical tinnitus associated with Morbus Menière is of a low frequency. The impairment caused by the tinnitus in this case is often only moderate or even minor.
Aura
Preceding the attacks patients frequently experience a sensation of pressure in the affected ear as well as an intensification of the tinnitus, symptoms which may announce the onset of a new attack to the patient.