From the Guidelines
Meniere's disease presents as episodic attacks of vertigo lasting 20 minutes to several hours, accompanied by fluctuating sensorineural hearing loss, tinnitus, and aural fullness in the affected ear. The clinical presentation of Meniere's disease is characterized by these episodic attacks, which can significantly impact a patient's quality of life 1.
Clinical Presentation
Key features of the clinical presentation include:
- Episodic vertigo lasting 20 minutes to 12 hours
- Fluctuating sensorineural hearing loss
- Tinnitus
- Aural fullness in the affected ear
Recommended Workup
The recommended workup for Meniere's disease includes:
- Thorough history and physical examination
- Audiometry to document hearing loss
- Vestibular function tests
- Imaging studies (MRI) to rule out other causes
Treatment Recommendations
Treatment involves both management of acute attacks and prevention of future episodes, with a focus on lifestyle modifications, medical therapy, and in some cases, surgical interventions. For acute attacks, vestibular suppressants like diazepam (2-10 mg orally) or meclizine (25-50 mg orally) can provide symptomatic relief 1. Long-term management starts with lifestyle modifications including low-salt diet (less than 2g sodium daily), avoiding caffeine, alcohol, and tobacco, and stress reduction. Medical therapy includes diuretics such as hydrochlorothiazide (25-50 mg daily) or acetazolamide (250 mg twice daily) to reduce endolymphatic fluid. Betahistine (16-24 mg three times daily), though not FDA-approved in the US, is widely used internationally. For refractory cases, intratympanic gentamicin (0.4-0.7 ml of 26.7 mg/ml solution) can be administered to ablate vestibular function, or intratympanic steroid injections (dexamethasone 4 mg/ml) may be tried. Surgical options include endolymphatic sac decompression, vestibular neurectomy, or labyrinthectomy for severe cases unresponsive to medical management.
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, as emphasized in the clinical practice guidelines for Meniere's disease 1.
From the Research
Clinical Presentation of Meniere's Disease
- Meniere's disease is characterized by episodic vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus 2, 3, 4
- The pathologic process involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops 2
- Vertigo is often the most debilitating symptom associated with Meniere's disease 2, 5
Recommended Workup for Meniere's Disease
- Diagnosis is based on clinical presentation and symptoms 2, 3, 4
- No specific workup is recommended, but a low-salt diet and diuretic may be used as initial management 2
- Vestibular suppressant drugs may be used to control acute attacks of vertigo 3
Treatment Recommended for Meniere's Disease
- Medical management is the primary treatment, with vestibular suppressant drugs and benzodiazepines used to control acute attacks of vertigo 3
- Long-term management includes a low-salt diet, diuretics, and histaminergic agents 3
- Intratympanic injection of gentamicin may be used in patients with persistent vertigo despite optimal medical management 6, 2, 5
- Corticosteroids may be used in bilateral forms of Meniere's disease, particularly if an autoimmune basis is suspected 3
- Surgical indications are rare, and the least invasive procedures are used first 3