Ménière’s disease

Medicine > Neurosciences

Overview

• Definition: A chronic inner ear condition causing episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear.
• Affects the labyrinth of the inner ear.

Etiology

• Exact cause unknown, but believed to be related to an increased fluid (endolymph) volume in the inner ear.
• May be linked to:
  • Allergies
  • Autoimmune response
  • Viral infections
  • Genetic predisposition

Clinical Features

• Vertigo: Severe spinning sensation, often causing nausea and vomiting.
• Fluctuating hearing loss, predominantly low frequency.
• Tinnitus: Ringing, buzzing, or hissing in the affected ear.
• Aural fullness: Feeling that the ear is full or congested.
• Episodes can last from 20 minutes to several hours, but not more than 24 hours.

Investigations

• Audiometry: To assess the degree and type of hearing loss.
• Vestibular tests: To check the balance function.
• MRI: To rule out other causes, like an acoustic neuroma.

Management

• Acute attacks:
  • Prochlorperazine or other anti-emetics for nausea.
  • Vestibular sedatives like cinnarizine or betahistine.
• Long-term management:
  • Betahistine: May reduce the frequency and severity of attacks.
  • Diuretics: To reduce the volume of endolymph.
  • Dietary salt restriction and avoidance of caffeine and alcohol.
  • Vestibular rehabilitation exercises.
  • Invasive treatments for refractory cases: Gentamicin injections, vestibular nerve section, endolymphatic sac decompression surgery.

Complications

• Progressive hearing loss which may become permanent.
• Increased risk of falls during vertigo attacks.

Key Points

• Diagnosis is mainly clinical.
• Ménière’s disease is a long-term, progressive condition, but treatments can help manage symptoms.
• Regular audiometric evaluations are important to monitor hearing.