Training with Meniere's disease and vertigo

author : AMSSM

comments : 3

Is it possible to train and race triathlons while coping with symptoms of Meniere's?

Member Question:
"I was diagnosed with Meniere's disease about 12 years ago. For the most part I have been able to control the symptoms (vertigo attacks, tinnitus) with low salt diet and exercise. In January I had one of the most violent vertigo attacks of my life. Luckily my husband was with me when the attack occurred. We were out for a walk. I had some symptoms brewing: fullness in my ear with ringing and pressure in my head, and I thought a walk would do me good. Out of nowhere I was thrown violently to the ground, hit my head and blacked out just for a few seconds. I had plenty of scrapes and bruises but no broken bones. Usually I can tell when I am going to have an attack because it comes on gradually starting with dizziness before spinning sets in. This was much different, it felt as though someone came from behind me and hit me with a sledgehammer. Needless to say it scared the heck out of me. My husband has never seen anything like it either, he said at first he thought I had tripped but I did nothing to break my fall. A real face plant, is how he described it.

Just wondering if I can be a triathlete with Meniere's? My issue now is getting back on my bike. If this had happened when I was on my bike I can only imagine how I would have ended up. It scares the heck out of me. Same with driving my car. I know now that if I have even the smallest inkling that I might have an attack I will not be driving or riding the bike.

Answer by Rob Strominger, MD, and Andrew Getzin, MD
Members AMSSM

Meniere's disease is named after a French physician Prosper Meniere who ran a school for the deaf in the 1860s in Paris. He was the first to show that vertigo, a type of dizziness where there is a feeling of motion when one is stationary, was caused by a peripheral injury to the ear.

Meniere's disease is thought to be caused by the buildup of fluid (endolymph) in the inner ear, called endolymphatic hydrops. When the pressure of this fluid builds up enough, there is a rupture of a thin membrane, release of fluid, and the development of symptoms. As you mentioned, patients are put on a low salt diet to try to prevent rupture from occurring.

The classic symptoms of Meniere's disease are episodic hearing loss, tinnitus and vertigo. Over time there is progressive hearing loss. However, we now know that there are Meniere's variants. If your most recent vertigo was from Meniere's, it is called a drop attack or otolithic crisis of Tumarkin. Meniere's disease is usually one ear but in about 20 percent of people it can affect both ears. It occurs in both men and women. In women it can be linked to the menstrual cycle.

Meniere's disease is not the only cause of vertigo. Other causes of vertigo are:

1. Viral labyrinthitis, when the common cold virus gets into and then damages the inner ear;
2. Intoxication;
3. Postural or orthostatic hypotension, when there is a drop in blood pressure and cerebral blood flow immediately after standing up or with strenuous exercise;
4. Heart arrhythmias, that lead to a decrease in cerebral blood flow.

There are many other causes, but the point is that, given the fact that this episode was so different than all the rest of your Meniere's attacks, you should consider making an appointment with your doctor. You should also get your hearing checked and have a consultation with an otolaryngologist (an ear, nose or throat physician).

Let's assume that this current episode was a severe Meniere's attack. There might not have been anything you could do about it, but it is possible that it was diet related. Did you eat something with salt in it? Or perhaps this was from hormonal changes? Have you started or stopped birth control pills?

Besides maintaining a low salt diet, there is other treatment available for Meniere's disease. The most common type of medicine prescribed in the United States is diuretics. They are thought to work by preventing the hydrops from forming. Betahistine, an oral form of histamine, is most commonly prescribed in Europe. The least invasive surgical procedure that is effective in some people is the placement of a tympanostomy tube in the affected ear-although this may require you to swim with an earplug. For severe cases more aggressive options are available.

I agree with your level of concern with biking and riding. While symptomatic, I would be very careful with biking outside. Consider training on an indoor trainer. In addition, don't swim alone. The good news about Meniere's disease is that it spontaneously improves in 60 to 80 percent of patients. So, don't give up on triathlon, train smart, and get some medical advice.

Andrew Getzin, MD
Clinical Director of Sports Medicine and Athletic Performance
Cayuga Medical Center
Ithaca, NY 14850
www.cayugamed.org/sportsmedicine
All American USAT 2008, 2009, 2010

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date: May 24, 2011