Ménière’s Disease: Symptoms, Causes, and Acupuncture Treatment

Ménière’s disease, also known as inner ear vertigo, is a clinical syndrome characterized mainly by episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the head.

The etiology of this disease remains unclear; it may be related to autonomic nervous dysfunction caused by fatigue, emotional agitation, psychological frustration, and other factors. In recent years, some have also considered it to be associated with endocrine-metabolic disorders, allergic reactions from various causes, and viral infections.

The pathogenesis currently accepted by scholars generally includes two theories: **First theory:** Factors such as fatigue, mental trauma, and emotional fluctuations induce dysfunction of the autonomic nervous system, causing vasospasm in the membranous labyrinth of the inner ear, microcirculatory disturbance, insufficient blood supply to the cochlea, and local neuroepithelial hypoxia. This leads to reduced production of endolymph, accumulation of intermediate metabolites, increased osmotic pressure within the membranous labyrinth, and subsequent infiltration of lymph and local fluid, resulting in endolymphatic hydrops. The elevated pressure stimulates and damages the vestibule, causing vertigo and balance disorders, while stimulating the cochlea leads to tinnitus and hearing loss. When endolymphatic pressure further increases, it may cause rupture of the vestibular basilar membrane or the wall of the saccule. Repeated long-term episodes cause degenerative changes in the inner ear receptors and basilar membrane, leading to permanent damage. **Second theory:** The membranous labyrinth is considered a closed system, with all parts connected by small ducts. Local metabolic disturbances, allergic reactions, endocrine disorders, infections, and other factors cause polymerization and depolymerization changes of mucopolysaccharides in the endolymph. These substances deposit in the small ducts, causing obstruction. In the obstructed segment of the membranous labyrinth, endolymph absorption decreases, raising its pressure, while the pressure in the other obstructed segment is relatively lower. When the pressure difference between the two reaches a certain threshold, the endolymph in the high-pressure area suddenly flows into the low-pressure area by reopening the originally obstructed ducts. This sudden, active flow of endolymph within the membranous labyrinth stimulates the vestibular and cochlear receptors, triggering vertigo, tinnitus, and hearing impairment.

【Diagnostic Points】

Clinical manifestations can be summarized into the following four types:

1. Paroxysmal Vertigo

Occurring without any warning signs, it presents as sudden onset of rotational vertigo (Xuanyun), with a sensation that surrounding objects or the patient’s own body are spinning. Alternatively, there may be a feeling of lightheadedness, unsteadiness, and a floating or sinking sensation. In severe cases, it is accompanied by autonomic nervous system stimulation symptoms such as nausea, vomiting, sweating, pallor, and bradycardia. During the peak of an episode, horizontal or horizontal-rotary nystagmus is often present; the nystagmus intensifies when gazing toward the affected side. As the vertigo subsides and resolves, the nystagmus disappears accordingly. The above symptoms are typically aggravated by changes in posture or head movements, so that during an acute attack the patient tends to keep the eyes closed.

Patients are confined to bed, afraid to turn over or move their head. Vertigo (Xuanyun) typically persists for several hours to several days, and some patients may have residual mild dizziness and head distention. The condition may recur at intervals of weeks, months, or years, and symptoms may completely disappear between episodes. However, after multiple attacks, the interictal period often shortens. Tinnitus and deafness worsen with the onset of vertigo, while the vertigo itself tends to diminish as deafness progresses. When complete deafness develops, vertigo ceases because vestibular function is simultaneously lost. In some patients, attacks may resolve spontaneously after several episodes.

2. Hearing Loss (Tingli Jiantui)

In the early stage, since most cases are unilateral and the hearing loss is mild, it often goes unnoticed and is overlooked. After repeated episodes, hearing gradually deteriorates, and half of the patients may even develop severe deafness. Some patients, despite hearing loss, find high-frequency tuning fork sounds irritating. Hearing loss may precede the onset of vertigo (Xuanyuan), and each vertigo episode can further worsen the hearing. During the interictal period, hearing often partially or fully recovers, manifesting as a characteristic fluctuating hearing phenomenon. However, after multiple episodes, it becomes difficult to return to the original level. In the late stage, sensorineural hearing loss occurs, and a few patients progress to complete hearing loss.

3. Tinnitus (Erming)

This condition may be the earliest manifestation of inner ear irritation. The vast majority of patients experience tinnitus before the onset of vertigo. Initially, the tinnitus is fluctuating, mostly presenting as low-frequency sounds resembling the roar of machinery or the buzzing of mosquitoes and flies, with varying severity. The tinnitus intensifies during vertigo episodes and gradually diminishes or disappears after the attack. With repeated occurrences, it may become persistent or permanent, manifesting as high-frequency sounds like cicada chirping or mixed tones.

4. Head Distension and Fullness

Before, during, and after an episode, patients often experience a sensation of fullness and stuffiness in one side or the entire head, yet this is frequently overlooked. Some patients report a feeling of heaviness in the head and lightness in the feet (head heavy, feet light), along with a sensation of stuffiness or oppression. A careful inquiry into the medical history can generally reveal these symptoms.

The main diagnostic criteria for this disease are: recurrent episodes of vertigo accompanied by nausea and vomiting, with the recurrence of vertigo being associated with worsening of cochlear symptoms. Hearing tests demonstrate unilateral sensorineural hearing loss; the alternate binaural loudness balance test and electric response audiometry indicate recruitment phenomena; and vestibular function tests confirm a peripheral vestibular disorder. Additionally, all cranial nerves except the eighth cranial nerve are normal, and temporal bone X-rays and otoscopy are normal. When the above conditions are met, the diagnosis is usually not difficult. However, some patients present with atypical manifestations; in the early stage of the disease, only episodic auditory symptoms occur.

Muscle weakness or vertigo often complicates diagnosis.

**Treatment**

I. Acupoints and Needling Techniques

1. Taiyang (EX-HN5) (bilateral): Located in the temporal region, in the depression 1 cun posterior to the midpoint between the lateral end of the eyebrow and the outer canthus. Use a 30-gauge, 2-cun filiform needle; perform routine local disinfection. Insert obliquely towards GB8 (Shuaigu) to a depth of approximately 1.8 cun. Needling sensation: distention and pain in the temporal region.

2. GB8 (Shuaigu) (bilateral): Located in the temporal region, 1.5 cun directly above the apex of the ear. Use a 30-gauge filiform needle of 1.5 cun. After routine local sterilization, insert obliquely toward the occiput for about 1.3 cun. Needle sensation: distension and pain in the temporal region.

3. **GB20 (Fengchi)** (bilateral): Located on the nape of the neck, in the depression between the upper ends of the sternocleidomastoid and trapezius muscles, level with **GV16 (Fengfu)**. A 0.30 mm × 50 mm (gauge 30, 2 cun) filiform needle is used. After routine local disinfection, insert obliquely toward the vertebral column to a depth of approximately 1.6 cun. Needling sensation: local distension and pain, or radiation to the occipital and temporal regions.

2. Methods

The patient assumes a sitting or semi-reclining position. The acupoints are needled according to the proper technique, retained for 40 minutes, and then removed. During retention, the needles are twisted once. Treatment is administered once daily, with six sessions constituting one course. Those who recover within six sessions discontinue treatment; those who show improvement but have not fully recovered after six sessions rest for three days before resuming needling; those who show no response after six sessions discontinue treatment.

【Commentary】

The prognosis for this condition is favorable. Acupuncture treatment can achieve excellent results in relieving vertigo during the acute phase. In most patients, vertigo is reduced or resolved within approximately 10 minutes after needle insertion. Some patients recover the ability to open their eyes, sit up, walk, or even fully recover after just one session of acupuncture. For patients in the advanced stage with recurrent episodes and residual deafness and tinnitus, a longer course of treatment is required, but satisfactory results can still be obtained.

Understanding Ménière’s Disease and Its Classic Symptoms

Ménière’s disease is a chronic disorder of the inner ear that manifests through a distinct cluster of clinical features. The hallmark presentation involves Meniere’s disease episodic vertigo symptoms, which include sudden, severe spinning sensations lasting from 20 minutes to several hours. These attacks are often accompanied by fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The vertigo episodes are profoundly debilitating, frequently inducing nausea, vomiting, and imbalance, thereby significantly impairing daily functioning. The auditory symptoms typically affect one ear initially but may become bilateral over time. The fluctuating nature of hearing loss distinguishes Ménière’s disease from other vestibular disorders, as patients often report periods of normal hearing interspersed with sudden deterioration during attacks. Tinnitus, commonly described as a low-frequency roaring or hissing, often intensifies preceding or during an episode. Recognizing these core features is essential for accurate diagnosis and timely intervention to mitigate disease progression.

Exploring the Causes and Triggers of Ménière’s Disease

The precise etiology of Ménière’s disease remains incompletely understood, but it is strongly associated with endolymphatic hydrops—an abnormal accumulation of fluid within the membranous labyrinth of the inner ear. Meniere’s disease causes and triggers are multifaceted and include autonomic nervous system dysfunction, often precipitated by fatigue, emotional stress, or psychological frustration. Endocrine and metabolic disturbances, such as thyroid disorders or glucose intolerance, have also been implicated. Additionally, allergic reactions to environmental or dietary factors may provoke immune-mediated inflammation, exacerbating hydrops. Viral infections and genetic predisposition are considered contributory in some cases. Environmental triggers, such as high sodium intake, caffeine, alcohol, and barometric pressure changes, can precipitate acute episodes. Understanding these triggers is crucial for patients and clinicians to develop personalized management strategies aimed at reducing attack frequency and severity.

Conventional and Acupuncture-Based Treatment Approaches

Management of Ménière’s disease requires a multidisciplinary approach targeting symptom control and functional preservation. Conventional inner ear vertigo tinnitus hearing loss treatment includes pharmacotherapy with diuretics, betahistine, and vestibular suppressants, alongside dietary salt restriction. For refractory cases, intratympanic corticosteroid injections or gentamicin ablation may be employed. In recent years, acupuncture has emerged as a promising adjunctive therapy. Acupuncture is believed to modulate autonomic nervous activity, improve inner ear microcirculation, and reduce endolymphatic pressure. Clinical studies suggest that regular acupuncture sessions can decrease the frequency and intensity of vertigo attacks, alleviate tinnitus, and stabilize hearing thresholds. This integrative approach offers a low-risk option for patients seeking complementary relief, particularly when conventional treatments provide insufficient control or cause adverse effects.

Natural Remedies and Lifestyle Management for Vertigo Attacks

Beyond medical and acupuncture interventions, patients often explore natural remedies for Meniere’s vertigo attacks to minimize episode impact. Dietary modifications, particularly reducing sodium intake to under 2,000 mg daily, are foundational to managing fluid balance. Avoidance of known triggers such as caffeine, alcohol, and monosodium glutamate can prevent sudden onset of symptoms. Ginger and ginkgo biloba supplements have been anecdotally reported to alleviate vertigo and tinnitus through their anti-inflammatory and vasodilatory properties, though rigorous clinical evidence remains limited. Stress reduction techniques, including mindfulness meditation and progressive muscle relaxation, help modulate autonomic dysregulation. During an acute attack, patients are advised to lie still in a dark, quiet room and focus on a fixed point to reduce disorientation. These non-pharmacological strategies empower individuals to gain some control over their condition while complementing formal treatment.

Long-Term Prognosis: Can Ménière’s Disease Cause Permanent Hearing Loss?

A critical concern for patients is whether can Meniere’s disease cause permanent hearing loss. The answer is yes: recurrent episodes of endolymphatic hydrops can