Ménière’s Disease

Ménière’s disease is a long-term inner ear disorder that causes recurrent attacks of vertigo, and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear. 

TOM TIP: Remember the typical triad of symptoms in Ménière’s disease, as this is commonly tested in exams:

  • Hearing loss
  • Vertigo
  • Tinnitus

 

Pathophysiology

Ménière’s disease is associated with the excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals. This increased pressure of the endolymph is called endolymphatic hydrops. 

 

Presentation

The typical patient is 40-50 years old, presenting with unilateral episodes of vertigohearing loss, and tinnitus.

Vertigo in Ménière’s disease comes in episodes. These last for 20 minutes to several hours before settling. These episodes can come in clusters over several weeks, followed by prolonged periods (often months) without vertigo symptoms. Vertigo is not triggered by movement or posture.

Hearing loss in Ménière’s disease typically fluctuates at first, associated with vertigo attacks, then gradually becomes more permanent. It is sensorineural hearing loss, generally unilateral and affects low frequencies first.

Tinnitus initially occurs with episodes of vertigo before eventually becoming more permanent. It is usually unilateral.

Other symptoms can include:

  • A sensation of fullness in the ear
  • Unexplained falls (“drop attacks”) without loss of consciousness
  • Imbalance, which can persist after episodes of vertigo resolve

 

Spontaneous nystagmus may be seen during an acute attack. This is usually in one direction (unidirectional). 

 

Diagnosis

Diagnosis of Ménière’s disease is clinical, based on the signs and symptoms. It will be made by an ear, nose and throat (ENT) specialist.

Patients will need an audiology assessment to evaluate hearing loss. 

 

Management

Management involves:

  • Managing symptoms during an acute attack
  • Prophylactic medication to reduce the frequency of attacks

 

For acute attacks, short-term options for managing symptoms include:

  • Prochlorperazine
  • Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

 

Prophylaxis is with:

  • Betahistine

 

Last updated July 2021
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