From the Guidelines
Ménière's disease is an ongoing inner ear disorder characterized by symptoms of vertigo, fluctuating hearing loss, tinnitus, and ear fullness.
Key Characteristics of Ménière's Disease
- Vertigo: lasts between 20 minutes to 24 hours, making the patient feel like they are spinning or moving when they are still 1
- Fluctuating hearing loss: hearing loss that worsens and improves over time, often affecting low to mid frequencies 1
- Tinnitus: a ringing, buzzing, or other noise in the ear when there is no external source of the noise 1
- Ear fullness: a feeling that the ear is full or plugged 1
Diagnosis and Treatment
Diagnosis is made based on a history of symptoms and may involve additional testing such as audiograms, video- or electronystagmogram, and electrocochleography 1. Treatment approaches include lifestyle modifications (e.g., low-sodium diet, limiting alcohol and caffeine intake), medications (e.g., diuretics, antivertigo medications), noninvasive therapies (e.g., vestibular rehabilitation, hearing aids), and surgery (e.g., endolymphatic sac decompression, vestibular nerve section) 1. 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 1.
From the Research
Definition and Symptoms of Ménière's Disease
- Ménière's disease (MD) is a severe inner ear condition characterized by debilitating symptoms, including spontaneous vertigo, fluctuating and progressive hearing loss, tinnitus, and aural fullness or pressure within the affected ear 2.
- The disease is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness 3.
- MD is a chronic condition with a prevalence of 200-500 per 100,000 and characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus, aural pressure, and a progressive loss of audiovestibular functions 4.
Pathophysiology and Diagnosis
- A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells 3.
- The diagnosis of MD 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 3.
- MRI has been optimized to directly visualize EH in the cochlea, vestibule, and semicircular canals, and its use is shifting from the research setting to the clinic 3, 4, 5.
Treatment and Management
- The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks 3.
- Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment 3.
- Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation 6.
- The first goal of the management of MD is to reduce the attack frequency, and several safe and effective medical and surgical therapies are practiced to help patients control vertigo and preserve hearing 5.