What is the difference between Ménière's disease and labyrinthitis?

From the Guidelines

Ménière's disease and labyrinthitis are distinct inner ear disorders with different characteristics and treatments, and the primary goal of treatment should be to reduce morbidity, mortality, and improve quality of life. Ménière's disease is a chronic condition characterized by episodic vertigo attacks lasting 20 minutes to several hours, fluctuating hearing loss, tinnitus, and aural fullness, as described in the clinical practice guideline by 1. In contrast, labyrinthitis is an acute inflammatory condition of the inner ear, typically viral in origin, causing severe vertigo lasting days to weeks, possible hearing loss, and nausea, as outlined in the study by 2.

The key differences between the two conditions are:

• Duration of vertigo: Ménière's disease has episodic vertigo attacks, while labyrinthitis has severe vertigo lasting days to weeks
• Hearing loss: Ménière's disease has fluctuating hearing loss, while labyrinthitis has possible hearing loss
• Pathophysiology: Ménière's disease involves endolymphatic hydrops, while labyrinthitis results from inflammation of the labyrinth

Treatment for Ménière's disease includes:

• Salt restriction
• Diuretics like hydrochlorothiazide 25mg daily
• Betahistine 16mg three times daily in some countries
• Sometimes intratympanic steroid or gentamicin injections for refractory cases, as recommended by 3

Treatment for labyrinthitis focuses on symptom management during the acute phase with:

• Vestibular suppressants like meclizine 25mg every 4-6 hours as needed
• Antiemetics
• Short-term corticosteroids in some cases, as described in the study by 2

It is essential to educate patients with Ménière's disease about the natural history, measures for symptom control, treatment options, and outcomes, as recommended by 4. This education can help patients manage their symptoms and improve their quality of life. Clinicians should also document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Ménière's disease, as suggested by 3.

In terms of diagnosis, clinicians should obtain an audiogram when assessing a patient for the diagnosis of Ménière's disease, as recommended by 3. They should also ask patients detailed questions about the vertigo attacks, including the nature of the onset, duration of active vertigo, and concurrent otologic symptoms, as described in the study by 2.

Overall, the treatment and management of Ménière's disease and labyrinthitis should prioritize reducing morbidity, mortality, and improving quality of life, and clinicians should follow the recommendations outlined in the clinical practice guidelines by 1, 2, and 3.

From the Research

Ménière’s Disease

• Ménière’s disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure 5
• The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear 5
• Treatment options for MD include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation 5

Labrythritis

• There is no information available in the provided studies regarding labrythritis, suggesting that it may not be directly related to the topic of Ménière’s disease or that there is a lack of research on this specific condition in relation to Ménière’s disease

Comparison of Ménière’s Disease and Labrythritis

• Due to the lack of information on labrythritis, a direct comparison between Ménière’s disease and labrythritis cannot be made based on the provided studies
• However, it is clear that Ménière’s disease is a well-studied condition with established diagnostic criteria and treatment options, whereas labrythritis is not mentioned in the provided studies 5, 6, 7, 8, 9

Treatment Options for Ménière’s Disease

• Betahistine has been shown to be effective in reducing vertigo attacks and facilitating postoperative compensation after vestibular neurectomy 6
• Acetazolamide has also been used to treat Ménière’s disease, but it is associated with a high rate of adverse events such as sensory disturbances, electrolyte imbalances, and liver dysfunction 7
• Other treatment options for MD include sodium restriction, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation 5