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Ménière’s disease

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

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