Ménière's disease: symptoms, how long attacks last and treatment

The inner ear holds both the organ of hearing, the cochlea, and the balance organs. In Ménière's disease these parts misbehave in episodes. The NHS describes a rare condition that can affect your balance and hearing, with symptoms that come and go. NHS inform adds that symptoms and severity vary widely from person to person.

Both sources stress that it is a long-term condition without a cure. They also stress that it can be managed, and that many treatments target single problems such as vertigo, tinnitus or hearing loss rather than the underlying process.

NHS inform lists the main symptoms as vertigo, meaning the feeling that you or the room is moving or spinning, tinnitus, hearing loss with particular difficulty hearing deep or low sounds, a feeling of pressure or fullness deep inside the ear, and feeling or being sick. The NHS adds loss of balance and pain or discomfort deep in the ear. Other features NHS inform mentions are sensitivity to sound (hyperacusis) and distorted sound.

At first only one ear is usually affected, although both ears can be involved over time, says NHS inform. The NHS says that after repeated episodes hearing may get gradually worse and tinnitus may become constant.

Vertigo is more than ordinary dizziness. The NHS describes it as a spinning sensation strong enough to affect balance, and notes that an attack can last from seconds to hours. In Ménière's disease the vertigo is typically accompanied by the ear symptoms listed above, which helps separate it from other causes.

• Vertigo and loss of balance.

• Ringing, buzzing or other tinnitus in one or both ears.

• Hearing loss, particularly for low-pitched sounds.

• Pressure, fullness or discomfort deep in the ear.

• Nausea and vomiting during the attack.

There are two answers: how long one attack lasts, and how long the condition lasts. The NHS says symptoms start suddenly and can last anywhere between a few minutes and 24 hours, and that some people have symptoms more often than others. NHS inform says symptoms typically last around 2 to 3 hours, although it can take a day or two for them to disappear completely.

As a condition, Ménière's disease is long term. Both the NHS and NHS inform say it cannot be cured, but that treatment can help the symptoms. The NHS says that over time hearing may gradually get worse and tinnitus may become constant. NHS inform adds that it usually affects one ear at first, but both ears may become affected over time.

Treatment is built around symptoms. Both NHS pages list medicines to help vertigo, nausea and vomiting, help for tinnitus (which can include different therapies), hearing aids, and vestibular rehabilitation to improve balance. NHS inform also lists a low-salt diet and relaxation techniques, and both say surgery on the inner ear is offered only rarely, when symptoms are hard to manage.

The NHS suggests keeping your medicines with you at all times, drinking plenty of fluids, talking to a GP about trying a low-salt diet, and trying to avoid caffeine in tea, coffee and chocolate. It advises not drinking alcohol and not smoking. Because attacks can come on without warning, it also suggests thinking about the risks of swimming, climbing ladders or using dangerous machinery.

For tinnitus the NHS describes CBT, tinnitus counselling and sound-based therapy, with digital CBT usually offered first, and says hearing aids may be recommended if there is hearing loss. For balance, the NHS says exercises or vestibular rehabilitation can help correct balance problems.

NHS inform says the exact cause is unknown. It is thought to involve a problem with pressure deep inside the ear. Risk factors it names are a family history of the condition and a chemical imbalance in the fluid of the inner ear.

Other conditions can look similar, and the NHS lists ear infections, labyrinthitis and vestibular neuritis, and migraine. Having these symptoms does not mean you definitely have Ménière's disease, which is why a pattern over time and some tests matter.

There is no single test. NHS inform explains that your GP asks you to describe your symptoms to look for a pattern. For a diagnosis it says you will have had at least 2 episodes of vertigo lasting 20 minutes or more within a single attack, tests confirming that hearing loss comes from damage to the sensitive hair cells inside the cochlea, and tinnitus or a feeling of pressure in the ear.

The NHS says a GP will ask about your symptoms, check inside your ears and look at your head and neck, and may ask you to march on the spot or stand with your heels together and your eyes closed. If Ménière's disease seems likely you are referred to a specialist for tests such as blood tests and an MRI scan. Hearing tests are central because they show whether the hearing loss fits the pattern.

The NHS says you must tell the Driver and Vehicle Licensing Agency (DVLA) if you have dizziness that comes on suddenly or happens often, and it advises not driving if you feel dizzy or vertigo is starting. NHS inform asks you to tell the DVLA about vertigo if you drive.

NHS inform adds that you should tell your employer if your job involves operating machinery or climbing ladders, and that vertigo may raise the chance of falling. It also notes that some people with Ménière's disease find the condition affects their mental health, and recommends speaking to your GP practice if you are finding it hard to cope. The NHS says counselling and relaxation techniques such as breathing exercises can help.

Most vertigo is not an emergency, but some features are. The NHS says to call 999 if you feel like you or everything around you is spinning and your face droops on one side, you cannot lift both arms and keep them there, you have difficulty speaking, you have sudden problems with vision in one eye, or you feel very off-balance, because these can be signs of a stroke. Do not drive yourself to A&E.

The NHS vertigo page adds that vertigo with a severe headache, being sick, or a very high temperature calls for an urgent GP appointment or NHS 111, and that double vision, hearing loss, trouble speaking or arm or leg weakness with vertigo needs 999 or A&E. Hearing loss is a normal part of Ménière's disease, so someone with a confirmed diagnosis will know their usual pattern; anything new or different, or a first-ever episode, should be treated as a reason to seek urgent advice rather than wait.

The usual route starts with a GP, who asks about your symptoms, looks in your ears and checks your head and neck. The NHS says that if Ménière's disease seems likely the GP refers you to a specialist for further tests, such as blood tests and an MRI scan, and NHS inform says an ear, nose and throat (ENT) specialist can carry out further tests if needed. Hearing tests are central to the diagnosis.

People who prefer to arrange an ENT or audiology appointment privately can do so, and the same information is useful there: when the attacks happen, how long they last, and any changes in your hearing. Whichever route you take, a symptom diary of dates, durations and triggers helps the specialist see the pattern. NHS inform also mentions support groups, and the NHS points to Ménière's & Vestibular UK for support.