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, diagnosed by symptoms of 2 or more episodes of vertigo that last between 20 minutes to 24 hours, as defined by the clinical practice guideline: Ménière's disease 1.
Key Characteristics
- Episodes of vertigo lasting between 20 minutes to 24 hours
- Fluctuating hearing loss
- Tinnitus: a ringing, buzzing, or other noise in the ear
- A feeling of fullness in the affected ear
Diagnosis
Diagnosis is made based on a history of symptoms, and may include additional testing such as:
- Audiogram: a hearing test to measure the level of hearing from low to high frequency 1
- Video- or electronystagmogram: an exam to evaluate vestibular function of the ear, the vestibular centers of the brain, and the oculomotor system 1
- Electrocochleography: a test to measure the electrical responses of the cochlea and auditory nerve to electrical stimulation 1
- Magnetic resonance imaging (MRI) of the brain: to rule out other causes of symptoms 1
Treatment
Treatment approaches include:
- Lifestyle modifications: reducing salt intake, avoiding caffeine, alcohol, and tobacco, and managing stress
- Medical therapy: diuretics such as hydrochlorothiazide or acetazolamide to reduce fluid buildup in the inner ear, vestibular suppressants like meclizine or diazepam to control vertigo and nausea, and oral steroids like prednisone for persistent symptoms 1
- Surgical options: intratympanic steroid or gentamicin injections, endolymphatic sac decompression surgery, or vestibular nerve section for refractory cases
Goals of Treatment
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 stated in the clinical practice guideline: Ménière's disease executive summary 1.
From the Research
Definition and Symptoms of Ménière's Disease
- Ménière's disease is an inner ear disease characterized by recurrent episodes of vertigo, accompanied by sensorineural hearing loss, tinnitus, and aural fullness 2, 3, 4, 5, 6
- The symptoms of Ménière's disease are discontinuous and variable in intensity, and can include discrete episodes of vertigo lasting 20 minutes or longer 2
- The disease is often associated with endolymphatic hydrops, although the exact pathophysiology is not fully understood 2, 4
Diagnosis and Treatment of Ménière's Disease
- Diagnosis of Ménière's disease is made with a characteristic patient history, including audiometry, a contrast-enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms 2
- Treatment of Ménière's disease typically begins with conservative measures, including a low-salt diet, avoidance of stress and caffeine, and sleep hygiene 2, 4, 6
- Medical therapy with a diuretic is often the next step, followed by intratympanic steroids and betahistine if symptoms persist 2
- Other treatment options include the Meniett device, endolymphatic sac surgery, and ablative therapies like intratympanic gentamicin 2, 3
Lifestyle and Dietary Interventions
- Lifestyle and dietary modifications, such as reducing salt and caffeine intake, are sometimes suggested to be of benefit for Ménière's disease 4, 6
- However, the evidence for these interventions is currently unclear, and more research is needed to determine their efficacy 6
- A low-sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet are some of the dietary modifications that have been suggested as first-line treatments for Ménière's disease 4
Vestibular Rehabilitation Treatment
- Vestibular rehabilitation treatment (VRT) has been shown to be an effective method for controlling vestibular symptoms in patients with various vestibular diseases, including Ménière's disease 5
- VRT may be beneficial for patients with Ménière's disease who experience persistent unsteadiness after intratympanic gentamicin treatment 5