How does vascular disease set off Meniere attacks?

Having hydrops is like walking a tightrope.  The ear is very vulnerable, on the edge of losing blood flow.  Slight changes, like eating a salty meal (Thanksgiving is notorious for this!) can put you at risk.  But hydrops alone doesn’t make the spell happen.  That requires a decrease in blood flow in the brain itself.  All the blood that courses through the inner ear comes in and exits through vessels in the brain, so if the brain blood flow is low, that adds to the problem in the inner ear.

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How does hydrops cause Meniere attacks?

The first thing a person has to have in order to have a Meniere attack is endolymphatic hydrops, a ballooning of the endolymph-filled labyrinth with a decrease of the cushioning perilymph fluid surrounding it.  Normally these compartments have a careful pressure-regulating system that keeps them from ballooning. Since the inner ear is a pressure sensor—sound exerts a slight pressure wave that the ear picks up, and so does movement—it is important that the ear has a constant, low pressure to allow these slight waves to be detected. When hydrops develops, it indicates that pressures have started to fluctuate.

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Meniere attack causes, continued

Some researchers felt that migraine was all that was needed to cause a Meniere attack, and others thought hydrops was the entire cause.  While this battle was going on in the literature, I continued to see hundreds of people with Meniere’s disease. 

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