How it affects you
MD is a fluctuating progressive illness and the symptoms vary between people, and with time in the individual person. It is useful to divide the course of the illness into three stages.
Stage 1: Early
The main feature is intermittent attacks of vertigo (giddiness) associated with nausea and vomiting. These attacks can last from a few minutes to 24 hours. During the attack there is a variable amount of hearing loss, and a sensation of fullness and discomfort in the affected ear. There may be tinnitus (noises in the ear) or an increase in existing tinnitus in the ear. The fullness in the ear and the tinnitus may precede the attacks of vertigo, but often the attacks occur without warning. Between attacks the hearing and sensation in the ear return to normal. The attacks vary in severity and length. There can be giddiness lasting a few minutes to severe rotational vertigo with vomiting, causing the person to lie completely still for several hours. There are periods of remission between the attacks, and these can vary from days to months or even years. The periods of remission vary in each person and with time, making MD an unpredictable and distressing illness.
Main problem(s): Unpredictable attacks of vertigo.
Stage 2: Intermediate
The attacks of vertigo continue, with variable remissions. They may be less severe. The attacks may be preceded or be followed by a period of imbalance and movement induced giddiness, adding to the distress. Permanent hearing loss develops and continues to fluctuate with the vertigo attacks. Tinnitus becomes more prominent; it also fluctuates, increasing with the attacks.
Main problem(s): Attacks of vertigo, tinnitus, hearing loss.
Stage 3: Late
In the later stages the hearing loss increases and often the attacks of vertigo diminish or stop. The disease affects both ears in up to 50% of people. Hearing loss can be severe and distortion, loudness discomfort and recruitment a problem. There is permanent damage to the balance organ in the ear and significant general balance problems are common, especially in the dark.
Main problem(s): Hearing loss, balance difficulties, tinnitus.
Associated problems
During severe attacks of vertigo, many people also suffer from diarrhoea, palpitations and sweating.
MD can severely affect the quality of life of the person. It can affect ability to work and travel. Families and relationships may suffer. Periods of depression and anxiety are common.
Necessary investigations to make a diagnosis
There is no specific test that, on its own, is reliable in diagnosing MD. Your General Practitioner and Ear Nose and Throat specialist will arrange appropriate investigations. The history and progression of the illness together with simple hearing (audiogram) and balance tests (caloric test) will be sufficient in many cases. However, the three main symptoms of vertigo, hearing loss and tinnitus occur in many other illnesses, and these may need to be excluded by tests (blood tests and MRI scan) before a final diagnosis can be made. Other investigations may help with the management and assessment of symptoms (postulography, electronystagmography, speech audiogram).