From the Guidelines
Meniere's disease is characterized by four main symptoms: episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness, with vertigo attacks typically lasting 20 minutes to several hours, often accompanied by nausea, vomiting, and balance problems 1. The condition usually affects one ear but can become bilateral in about 30% of cases. Other symptoms may include sensitivity to loud sounds, headaches, and loss of balance. Meniere's disease is thought to be caused by excess fluid buildup in the inner ear (endolymphatic hydrops), disrupting normal balance and hearing function. Some key points to note about Meniere's disease include:
- The condition typically affects adults between 40-60 years old and has no definitive cure, but symptoms can be managed with medications like antihistamines, anti-nausea drugs, diuretics, and lifestyle modifications such as reducing salt intake, avoiding caffeine and alcohol, and managing stress 1.
- During acute attacks, patients should lie down in a quiet, dark room with their eyes fixed on a stationary object until the vertigo subsides 1.
- The goals of treatment are to prevent or reduce the severity and frequency of vertigo attacks, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve overall quality of life 1.
It is essential to differentiate Meniere's disease from other causes of vertigo and dizziness, such as benign paroxysmal positional vertigo, vestibular migraine, and stroke or ischemia, as these conditions have distinct clinical presentations and require different management approaches 1. A thorough otologic history and physical examination are crucial in establishing the diagnosis and ruling out other potential causes of symptoms.
In terms of management, clinicians may offer a limited course of vestibular suppressants to patients with Meniere's disease attacks, and diuretics and/or betahistine may be used for maintenance therapy to reduce symptoms or prevent attacks 1. Vestibular rehabilitation/physical therapy may also be beneficial for patients who have failed less definitive therapy and have nonusable hearing.
Overall, Meniere's disease is a complex condition that requires a comprehensive approach to management, including lifestyle modifications, medical therapy, and potentially surgical intervention in severe cases. By prioritizing the management of vertigo, hearing loss, tinnitus, and aural fullness, clinicians can help improve the quality of life for patients with Meniere's disease 1.
From the Research
Signs and Symptoms of Meniere's Disease
The signs and symptoms of Meniere's disease include:
- Vertigo attacks 2, 3, 4, 5, 6
- Fluctuating hearing loss 2, 3, 4, 5, 6
- Tinnitus 2, 3, 4, 5, 6
- Aural fullness 2, 3, 4, 5, 6
- Disequilibrium and unsteadiness 3
- Headache during attacks 4
- Bilateral involvement in 25-40% of cases 4
Clinical Presentation
The clinical presentation of Meniere's disease is characterized by:
- 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 4
- Discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, aural fullness, and tinnitus 5
- Feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo 6
Diagnosis and Treatment
The diagnosis of Meniere's disease 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 4. Treatment options include:
- Conservative measures, such as low salt diet, avoidance of stress and caffeine, and sleep hygiene 5
- Medical therapy with a diuretic 5
- Intratympanic (IT) steroids and betahistine 5
- Vestibular rehabilitation physical therapy 3
- Surgical options, such as endolymphatic sac decompression surgery or cochlear implantation 2, 4