What is a summary of Ménière's (Inner Ear) disease?

From the Guidelines

Ménière's disease is a chronic inner ear disorder characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the affected ear, typically affecting one ear and caused by an abnormal amount of fluid (endolymph) in the inner ear. The goals of treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve quality of life 1. Management includes both lifestyle modifications and medications, with patients recommended to reduce salt intake to 1500-2000mg daily, avoid caffeine, alcohol, and tobacco, and manage stress 1.

Lifestyle Modifications

• Reduce salt intake to 1500-2000mg daily
• Avoid caffeine, alcohol, and tobacco
• Manage stress

Medications

• During acute attacks, medications like diazepam (2-5mg orally), meclizine (25-50mg orally), or promethazine (25mg orally or rectally) can help control vertigo
• For long-term management, betahistine (16mg three times daily) may reduce attack frequency, while diuretics such as hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) can help reduce fluid buildup 1

Treatment Approaches

• Noninvasive therapies: vestibular rehabilitation (physical therapy), hearing aids
• Middle ear injections: steroids, gentamicin
• Surgery: endolymphatic sac decompression (hearing sparing), vestibular nerve section (hearing sparing), labyrinthectomy (hearing ablative) 1

Disease Course and Prognosis

The disease follows an unpredictable course with spontaneous remissions and exacerbations, but many patients experience improvement over time as the brain compensates for vestibular dysfunction 1. Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Ménière’s disease after treatment 1.

Patient Education and Support

Patients should be encouraged to join a support group to gain knowledge, resources, and support from others, with resources available from organizations such as the Vestibular Disorders Association, Ménière’s Resources Inc, and the Ménière’s Society 1. Clinicians should educate patients with Ménière’s disease on dietary and lifestyle modifications that may reduce or prevent symptoms, with a focus on identifying and managing triggers such as allergies, which can contribute to symptoms in up to 30% of patients 1.

From the Research

Definition and Symptoms of Ménière's Disease

• Ménière's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness 2, 3, 4, 5.
• The disease is characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure 3.
• Symptoms can include spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus, and aural fullness or pressure within the affected ear 5.

Pathophysiology and Diagnosis

• A characteristic sign of MD 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 MD 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

• The management of MD 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.
• Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation 3.
• A systematic review and network meta-analysis found that IT steroid plus high-dose betahistine may be the best treatment option among pharmacologic interventions to achieve both hearing preservation and vertigo control 4.

Quality of Life and Multidisciplinary Approach

• The most tormenting symptom of MD is vertigo, followed by tinnitus and headache 6.
• The management of associated symptoms, such as headache and vegetative symptoms, is also of great importance 6.
• Monitoring the quality of life and psychiatric disorders suggests the importance of a multidisciplinary approach in the treatment of MD 6.