Is my vertigo Meniere’s?

(My doctor) says I have beginning of Meniere’s but I truly don’t believe so.  I only have one symptom, vertigo, no loss of hearing or ringing at time of the episode.  My vertigo comes on when my left ear is plugged and feels full of fluid due to allergies, (which I always have). Usually it hits when that ear is plugged and if I turn my head to the right or sleep on my right side, (ear that is usually affected) when I get up I feel a little off, then suddenly I get the spinning sensation even if eyes closed. Usually lasts  for a few seconds but better lying down.

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It can be hard to decide which vertigo problem a patient has when they first see a physician.  Often they have trouble describing the vertigo. They might say, “I just feel dizzy” and then when I ask them to describe the dizziness in more detail, they add “it’s really bad”. It’s not easy thinking of other words to describe what is felt inside unless very specific questions are asked. 

One of the most confusing decisions to make is whether the patient has Meniere’s disease, which is a serious condition that results in the gradual destruction of an ear, or another repeated kind of vertigo that isn’t nearly as dangerous, like BPPV (“bed spins”) for example. 

Meniere’s has four basic symptoms: hearing loss, ringing in the ear (tinnitus), fullness in the ear, and vertigo.  This very simple list overlaps with a lot of other conditions.  For example, an older person might have age-related hearing loss, with tinnitus from that hearing loss, allergies causing stuffy feelings, and positional vertigo.  Even though they have everything on the list, they do not have Meniere’s disease .  It is the subtle details that determine whether Meniere’s is the problem. 

In Meniere’s, the hearing loss, feeling of fullness, and tinnitus are all connected together.   In fact they are all different facets of hearing loss.  If you abruptly lose hearing in one ear, you will usually also hear a ringing sound in that ear.  The pitch of the ringing will match the tones that are impaired.  In Meniere’s, the hearing loss during a spell is in the low tones, so the “ringing” is more of a roaring sound, or the sound you hear when you hold a large coiled seashell to your ear.  It can sound like a jet engine or a vacuum cleaner.  People often say that the sound is so loud that it drowns out their hearing, but this is an illusion.  It is the hearing loss that results in the sound.  This can last for hours at a time, but when the sound eventually fades, the hearing also returns.  After many such spells, a different and more permanent hearing loss slowly develops, and there may be a different pitch to the accompanying more constant tinnitus. 

The feeling of fullness in the ear is also a part of the hearing loss.  If you suddenly lose hearing, you will feel a flattened, cottony feeling in your ear.  It’s rather like the feeling of getting water in your ear while swimming.  If your Eustachian tube gets blocked while flying, you can get a similar stuffy feeling and that also mildly affects hearing.  Unlike a blocked ear, however, you cannot “pop” your ear and get rid of the Meniere’s stuffiness.  It just gradually goes away as the spell ends. 

The vertigo of Meniere’s disease is unpleasant and nauseating, but the spinning is not as fast as in some other disorders like BPPV.  The spinning sensors of the ear shut off, and this results in a constant, quite steady spinning.  You can often see the environment spinning or shifting.  This is worse if you hold your gaze in one direction, and better if you look in the opposite direction.  Since the vertigo is  very long lasting, often for hours, it is typical to become nauseated.  Turning the head quickly when upright makes the vertigo worse.

Other conditions don’t have these more detailed symptoms.  Sudden damage to an ear causes hearing loss, fullness and tinnitus with vertigo, but these symptoms are constant for days to weeks.  All but the hearing loss usually decline over time.  BPPV causes short spells of vertigo brought on by lying with the affected ear down, and worsened when trying to arise.  If you also happen to have constant hearing loss and ringing from age, this still won’t mean you have Meniere’s disease. In Meniere’s, those symptoms mostly occur at the same time as the vertigo and last for long periods (up to hours).  Short bursts of vertigo when arising are  almost always BPPV, and being able to stop the vertigo by doing maneuvers proves it is not Meniere’s disease.   

Of course, no diagnosis is as easy as a few paragraphs can imply.  I have seen people start with BPPV, only to develop a destructive disorder of the inner ear as time goes by.  This means that having a hearing test periodically is a good idea if symptoms of hearing loss, ringing in the ear or repeated vertigo continue to occur.