What is Meniere's (Inner Ear) disease?

From the Guidelines

Meniere's disease is a chronic inner ear disorder that can be managed with lifestyle modifications, medications, and procedures to reduce symptoms and improve quality of life. The most recent and highest quality study, 1, recommends that treatment for Meniere's disease falls into several categories, including diet restrictions, medications, noninvasive therapies, and surgery.

Lifestyle Modifications

Lifestyle modifications are the first line of treatment for Meniere's disease, and include:

• Reducing salt intake to 1500-2300 mg daily
• Limiting alcohol consumption
• Limiting caffeine intake
• Managing stress

Medications

Medications may also be used to reduce symptoms, including:

• Diuretics to remove excess body fluid
• Antivertigo medications for acute vertigo symptoms
• Antihistamines to treat allergies
• Betahistine, a histamine analogue, to increase vasodilation to the inner ear

Noninvasive Therapies

Noninvasive therapies, such as vestibular rehabilitation and hearing aids, may also be beneficial in managing Meniere's disease.

• Vestibular rehabilitation (physical therapy) can help improve balance and reduce vertigo symptoms
• Hearing aids can help improve hearing and reduce tinnitus symptoms

Procedures

For severe cases unresponsive to medical therapy, procedures such as intratympanic steroid or gentamicin injections, endolymphatic sac decompression, or vestibular nerve section may be considered.

• Intratympanic steroid or gentamicin injections can help reduce vertigo symptoms and improve hearing
• Endolymphatic sac decompression can help reduce fluid buildup in the inner ear and improve symptoms
• Vestibular nerve section can help reduce vertigo symptoms, but may result in hearing loss

Quality of Life

Meniere's disease can significantly impact quality of life, causing symptoms such as vertigo, tinnitus, and hearing loss. However, with proper management, most patients can experience a significant reduction in symptoms and improvement in quality of life, as noted in 1.

Patient Education

Patient education is also an important aspect of managing Meniere's disease, as noted in 1. Clinicians should educate patients about the natural history of the disease, measures for symptom control, treatment options, and outcomes. This can help patients make informed decisions about their care and improve their quality of life.

Treatment Goals

The goals of treatment for Meniere's disease are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve quality of life, as noted in 1. By working with a healthcare provider, patients can develop a personalized treatment plan to manage their symptoms and improve their quality of life.

From the Research

Definition and Symptoms of Meniere's Disease

• Meniere's disease is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness 2.
• The disease is characterized by recurrent episodes of vertigo, hearing loss, tinnitus, and pressure in the ear 3.
• Symptoms of Meniere's disease can vary, but common signs include feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo 4.

Pathogenesis and Diagnosis of Meniere's Disease

• The exact root of Meniere's disease is not fully understood, but it is believed to involve several biological and bioenvironmental etiological factors such as genetics, autoimmunity, infection, trauma, allergy, and new theories, such as saccular otoconia blocking the endolymphatic duct and sac 5.
• A characteristic sign of Meniere's disease is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells 2.
• The diagnosis of Meniere's disease is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests 2.
• MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic 2.

Treatment and Management of Meniere's Disease

• The management of Meniere's disease is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks 2.
• Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment 2.
• The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy 6.
• As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy 6.
• When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids 6.
• Other treatment options include intratympanic gentamicin therapy or endolymphatic sac decompression surgery 2, and destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section 6.