Ménière’s disease

Medicine > Neurosciences

Background knowledge 🧠

Definition

Ménière’s disease is 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.

Aetiology

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 🌡️

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 🧪

Tests

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 🥼

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

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

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