Severe attacks of vertigo, usually associated with nausea and vomiting. The disease is prevalent in middle-aged men. The cause is thought to be accumulation of fluid in the semicircular canals of the inner ear; it is not known why the fluid is produced. The attacks usually occur without warning, although some patients feel them coming on. As well as the above symptoms the patient may faint, and suffer from ringing in the ears, poor hearing and nystagmus. There is little discomfort between attacks, and hearing improves slightly, although it deteriorates in the long run. The attacks usually last five to six hours, after which the patient falls into exhausted sleep. In general the attacks are unilateral (one-sided), in a quarter of cases they spread to the other ear in the short or long term. Meniere’s disease is not usually associated with other physical disorders, but similar symptoms can occur in cases of otitis media (inflammation of the inner ear) and tumour of the pons, in which case they are known as Meniere’s syndrome. Other illnesses causing vertigo must also be excluded; this requires hearing and balance tests, and possibly also more specialized investigation. Treatment of Meniere’s disease is directed at reducing discomfort; the disease itself is incurable. The patient should follow a healthy regime: good food and plenty of sleep, plenty of bodily movement and exercises, possibly combined with drugs which both tranquillize and reduce the vertigo. In this way discomfort can be reduced to an acceptable level. Sometimes an operation is attempted to make a connection between the semicircular canals and the inner ear, to release the excessive fluid.