Meniere's disease is an episodic auditory and vestibular disease characterised by sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear. Earlier in the disease process, all symptoms may not be present.
The cause is unknown, but results in an over-production or impaired absorption of endolymph in the inner ear.
Diagnosis is made on clinical history and detailed audiological tests; other investigations may be required to exclude other causes.
Dietary changes and diuretics may control symptoms in early stages of the disease; specific medical therapies for vertigo control can be tried if required.
If symptoms persist despite maximal medical therapy, several surgical interventions are available.
Meniere's disease (MD) or Meniere syndrome is an auditory disease characterised by an episodic sudden onset of vertigo, low-frequency hearing loss (in the early stages of the disorder), low-frequency roaring tinnitus, and sensation of fullness in the affected ear. Usually the terms are used interchangeably, but MD is commonly used if it is idiopathic (i.e., without known cause) and Meniere syndrome if it is secondary to a number of known inner-ear disorders. It is also called endolymphatic hydrops, because of the described pathological state observed on post mortem histological sectioning. It is unclear whether this is a cause of symptoms or a result of the pathological process.
History and exam
Key diagnostic factors
- presence of risk factors
- hearing loss
- aural fullness
- drop attacks
Other diagnostic factors
- positive Romberg's test
- Fukuda's stepping test
- bilateral symptoms
- tandem walk
- recent viral infection
- genetic predisposition
- autoimmune disease
1st investigations to order
- pure-tone air and bone conduction with masking
- speech audiometry
- tympanometry/immittance/stapedial reflex levels
- oto-acoustic emissions (OAE)
Investigations to consider
- rotary chair test
- vestibular-evoked myogenic potential (VEMP)
- MRI of internal auditory canals
- thyroid function tests
- Lyme disease and syphilis serology
- anti-nuclear antibody
- anti-neutrophil cytoplasmic antibody
- rheumatoid factor
- 3-dimensional MRI
persistent hearing loss
failure of medical and intratympanic therapies; hearing adequate
failure of medical and intratympanic therapies; hearing severely impaired
- Acoustic neuroma
- Vestibular migraine (also called migraine-associated dizziness and migraine-associated vertigo)
- Vestibular neuronitis
- Clinical practice guideline: Ménière's disease
- Clinical practice guideline: sudden hearing loss (update)
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