Is Meniere's disease caused by a viral etiology?

From the Guidelines

Meniere's disease is not definitively linked to a viral etiology, and its cause is more widely understood to be multifactorial, involving endolymphatic hydrops and various other factors. The condition is characterized by spontaneous vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness, with the underlying etiology not completely clear 1. While viral infections have been proposed as one possible cause, there is insufficient evidence to establish viruses as the primary or consistent cause of Meniere's disease. Some researchers have investigated herpes viruses as potential triggers, but these findings remain inconclusive.

Key Factors in Meniere's Disease

• Endolymphatic hydrops (excess fluid in the inner ear) is a key factor in the development of Meniere's disease symptoms, including vertigo, hearing loss, tinnitus, and aural fullness 1.
• The condition is multifactorial, involving various factors such as autoimmune responses, genetic predisposition, anatomical abnormalities of the inner ear, or circulatory problems 1.
• Treatment approaches are many and typically include modifications of lifestyle factors (e.g., diet) and medical, surgical, or a combination of therapies 1.

Diagnosis and Treatment

• Diagnosis of Meniere's disease is based on a thorough otologic history, physical examination, and additional testing such as audiogram, video- or electronystagmogram, electrocochleography, and magnetic resonance imaging (MRI) of the brain 1.
• Treatment typically focuses on symptom management rather than addressing a viral cause, using medications like diuretics (such as hydrochlorothiazide 25-50mg daily), anti-vertigo medications (like meclizine 25mg as needed), salt restriction, and in severe cases, procedures such as endolymphatic sac decompression or intratympanic gentamicin injections 1.
• The lack of consistent viral detection in affected patients and the variable response to antiviral therapies further suggests that viruses are unlikely to be the primary cause for most Meniere's disease cases.

Clinical Considerations

• Clinicians should ask patients detailed and specific questions about the vertigo attacks, including the nature of the onset, duration of active vertigo, and concurrent otologic symptoms just before, during, or after the vertigo attack 1.
• A thorough otologic history and medical/surgical history should be addressed at the time of evaluating a patient with suspected Meniere's disease, including prior ear surgery, otorrhea/chronic ear infections, otalgia, or prior hearing loss 1.

From the Research

Viral Etiology of Meniere's Disease

• There is evidence to suggest that viral infections, such as Herpes simplex virus, cytomegalovirus, Epstein Barr virus, influenza, adenovirus, Coxsackie virus B, and Varicella Zoster Virus, may be involved in the development of Meniere's disease 2.
• However, the evidence is inconsistent and the underlying mechanism remains theoretical 2.
• A study found that intratympanic application of an antiviral agent, ganciclovir, may be an efficient therapy for Meniere's disease, with control of vertigo achieved in 80% of patients 3.
• Another study suggested that antiviral therapy may be effective for a subset of patients with Meniere's disease, but the current evidence appears circumstantial and inconsistent 2.

Pathogenesis and Diagnosis of Meniere's Disease

• Meniere's disease is a disorder of the inner ear, characterized by endolymphatic hydrops, which causes damage to the ganglion cells 4, 5.
• 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 4.
• MRI has been optimized to directly visualize endolymphatic hydrops in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic 4.

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 4, 6.
• Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment 4.
• Intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered when medical treatment is unable to suppress vertigo attacks 4, 6.