From the desk of Teresa Goddard, M.S., Lead Consultant – Sensory Team
Ménière’s disease is a disorder of the inner ear caused by a buildup of a fluid called “endolymph” in a part of the ear known as the “labyrinth.” Endolymph is necessary for the normal functioning of the inner ear, but excessive amounts can interfere with the cells that send signals from the ear to the brain. This can cause problems with hearing and balance. There is no specific laboratory test for Ménière’s disease, so diagnosis is typically made based on information about the type, frequency, and nature of symptoms, and by ruling out other conditions that cause similar symptoms.
Ménière’s disease causes ringing in the ears (tinnitus), fluctuating hearing loss, a feeling of fullness in the ear, and episodes of severe dizziness or vertigo. In addition, people with Ménière’s disease may be more likely to have migraine headaches. It is not unusual to experience new or increased anxiety along with a diagnosis of Ménière’s disease. This may be caused in part by concern about where and when one will happen to be when unexpected dizziness and other symptoms occur. Depending on the person, vertigo resulting from Ménière’s disease may come on suddenly, or the person may experience ringing or buzzing in the ears or a loss of hearing before the onset of dizziness and difficulty balancing. Nausea may also accompany vertigo.
Treatment for Ménière’s disease involves managing symptoms such as vertigo using medication as well as attempting to modify levels and action of endolymph through low-sodium diets, medications such as diuretics, use of medical devices, and surgery when other treatments prove ineffective. Some individuals may also benefit from cognitive behavioral therapy to manage anxiety related to concern about future attacks of vertigo. Individuals may also use lifestyle changes and alternative medicine approaches such as avoiding caffeine and using exercise like Tai Chi in an effort to manage symptoms. Although more research is needed to know how effective lifestyle and alternative medicine interventions may be in modifying the course of Ménière’s disease, they may help to ease the stress and anxiety that people with Ménière’s disease experience as a result of the unpredictability of their symptoms.
Accommodation needs of employees with Ménière’s disease can be similar in many ways to the needs of employees who are hard of hearing, have tinnitus, or have balance difficulties, depending on what symptoms a person is experiencing. However, since the symptoms of Ménière’s disease come and go episodically, employees may not need to use the same accommodations all the time. Ideally, employees should be allowed to take the lead in deciding whether and when to use accommodations such as amplification and tinnitus masking, since symptoms such as hearing loss and tinnitus are not usually constant for those with Ménière’s disease.
In contrast, employees may need consistent support to maintain a diet, exercise, and medication regimen needed to manage their conditions, and may need time off for tests, treatments such as injections and surgeries, and to manage sudden exacerbations of symptoms. Employees may need certain accommodations only during episodic exacerbations of symptoms or “attacks.” It may make sense to consider offering to make a plan of action to plan ahead for exacerbations or attacks that occur at work, particularly if the individual is prone to severe vertigo and needs to rest and recover or relocate to a different work area temporarily, use rescue medications, or leave the workplace to go home or to receive treatment following an attack of vertigo.
Here is a sample "Plan of Action." It includes an example of how to fill out the form for a person with epilepsy, but it could be modified to assist an employee with a different impairment such as Ménière’s disease.
The following links to information on accommodations for employees with hearing impairment, vertigo, and ringing in the ears may be a good place to start when exploring accommodation ideas for employees with those symptoms.
For more information on accommodating employees with Ménière’s disease, please contact JAN.
- NIDCD. (2010). Fact Sheet: Ménière's Disease. Retrieved January 28, 2016, from http://www.nidcd.nih.gov/health/balance/pages/meniere.aspx
- Ménière’s Foundation. (2016). Ménière’s Disease. Retrieved January 28, 2016, from http://menieresfoundation.org/