Meniere’s vertigo attacks are recurrent episodes of severe vertigo, dizziness, tinnitus, and hearing loss (along with other symptoms) that occur spontaneously and last for minutes to hours, up to a day, then resolve.

The co-occurring symptoms include nausea, vomiting, loss of balance, unstable walking, fear of falling, anxiety, sweaty, clammy, and cold/ chills.

Transient hearing loss that returns to normal when the episode is resolved is characteristic of Ménière’s vertigo. Loud ringing or hissing typically accompanies that.

The presence of the hearing loss and ear noises can distinguish Meniere’s vertigo from episodes of Migraine Dizziness.

Meniere’s Disease

Meniere’s disease is idiopathic, meaning there is no known cause. This condition is also called Endolymphatic Hydrops.

A brain MRI is important in the diagnostic process in order to rule out a neurological condition that hopefully is negative, or “age-related normal.”

Patients typically get multiple hearing tests over the course of being diagnosed with Ménière’s disease: a baseline test, a second test during an attack, and a third test after the attack is over.

The hearing loss during a Meniere’s vertigo attack is typically in certain predictable frequencies.

Since it is difficult to get a hearing test during an attack, this diagnostic process is often incomplete.

However, an accurate diagnosis can still be made based on the history of symptoms alone, as an educated guess.

Over time, repeated attacks typically result in cumulative, permanent hearing loss.

Common triggers for Meniere’s Vertigo attacks

Salt (sodium) and caffeine could be triggering. Dietary changes are often recommended for Meniere’s vertigo.

Sodium and potassium balance typically plays a role in preventing future attacks.

Patients with Meniere’s vertigo typically take preventative medication, such as to balance fluid pressure in the ears.

Medication management and dietary changes are key to managing this vestibular disorder.

The exact medications recommended depend on the country where the patient lives.

The focus of care is on medical management to prevent future attacks.

Meniere’s Syndrome

Patients can also have “Meniere’s syndrome“, which is not true Ménière’s vertigo disease, but something else in the body that is causing Meniere’s-like attacks.

This is also called Secondary Endolymphatic Hydrops.

This syndrome mimics Ménière’s disease attacks but does not necessarily respond to medications and dietary changes.

The root cause can vary if Meniere’s vertigo is caused by a Meniere’s syndrome.

For example, ear surgery, an auto-immune disease, and orthopedic issues can all be a root cause of Meniere’s syndrome.

In this case, identifying the underlying root cause is the key treatment.

For example, if patients have upper cervical issues at C1, or a history or whiplash from 15-20 years ago, they may develop Meniere’s syndrome. Upper cervical care is the key to management in that type of case.

Here are some links to articles and glossary terms I’ve written on this topic:

  1. Do I Have Meniere’s Disease?
  2. Vestibular Physical Therapy for People with Ménière’’s Disease
  3. The Caffeine and Vertigo Link
  4. Meniere’s Disease
  5. Meniere’s Syndrome


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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