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 caused by an abnormal amount of fluid (endolymph) in the inner ear, as defined by the American Academy of Otolaryngology-Head and Neck Surgery in their 2020 clinical practice guideline 1.
Key Characteristics of Ménière's Disease
- 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 and Management
Diagnosis is made based on symptoms, including the frequency and duration of vertigo episodes, hearing loss, and other ear complaints, as outlined in the clinical practice guideline 1. Management includes lifestyle modifications, such as reducing salt intake to less than 2 grams daily, avoiding caffeine, alcohol, and tobacco, and managing stress. Medications like diazepam, meclizine, or promethazine can help control vertigo during acute attacks, while betahistine and diuretics like hydrochlorothiazide may reduce attack frequency and inner ear fluid, respectively 1.
Treatment Goals and Options
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 executive summary 1. Treatment approaches include modifications of lifestyle factors, medical, surgical, or a combination of therapies, with the choice of treatment considering the patient's hearing status and whether it is usable or not 1.
Patient Outcomes and Quality of Life
Clinicians should document the 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, as recommended in the clinical practice guideline 1. Proper management can significantly improve quality of life for most patients, despite the disease's unpredictable course with spontaneous remissions and exacerbations.
From the Research
Definition and Symptoms of Ménière's Disease
- Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus 2.
- It is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus 3.
- The disease is a chronic multifactorial disorder of the inner ear, with episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure 4.
Pathophysiology and Etiology
- The pathologic process involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops 3.
- The underlying cause of Ménière's disease is unknown, as is the way in which lifestyle or dietary interventions may work 2.
- Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system 4.
Diagnosis and Treatment
- The diagnosis of Ménière'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 sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation 4.
- Intratympanic administration of gentamicin has been proposed as an alternative for patients with debilitating Ménière's disease who have failed to respond to standard medical treatment 5.
- Lifestyle changes, dietary modifications, diuretics, vasodilator corticosteroids, and surgical methods are also used to prevent attacks, treat symptoms, and prevent permanent effects on the hearing and balance system 6.