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Updated: Dec 17 2021

Meniere Disease

  • Snapshot
    • A 26-year-old woman presents to her primary care physician for severe dizziness spells. Her dizziness is described as the room is spinning, and it typically lasts a few minutes. Her symptoms are associated with nausea and "ear ringing." At times she feels like her left ear has decreased hearing. She denies any lightheadedness or palpitations. Physical examination is unremarkable. She is referred for audiometry testing and was urged to decrease her salt and caffeine intake. She is prescribed meclizine for symptomatic improvement.
  • Introduction
    • Overview
      • an inner ear disorder leading to paroxysmal vertigo, tinnitus, and sensorineural hearing loss
  • Epidemiology
    • Demographics
      • 20-40 years of age
    • Location
      • inner ear labyrinthine system
    • Risk factors
      • family history
    • Pathophysiology
      • excessive fluid build-up in the endolymphatic system for unclear reasons
  • Presentation
    • Symptoms
      • episodic vertigo
        • rotatory spinning or rocking sensation
      • sensorineural hearing loss (typically fluctuating)
      • tinnitus
        • typically low pitch
      • aural fullness
    • Physical exam
      • none are specific for Meniere disease
  • Studies
    • Audiometry
      • indication
        • performed in all patients with Meniere disease
      • findings
        • low frequency sensory hearing loss
        • low and high frequency sensory hearing loss
        • normal hearing in mid frequency sounds
    • Vestibular testing
      • indication
        • performed in patients when determining if the patient is a candidate for intervention
        • to determine if there is bilateral disease
      • modalities
        • electronystagmography (ENG)
        • rotary chair testing
        • computerized dynamic posturography
  • Differential
    • Vestibular schwannoma
      • differentiating factors
        • rarely have vertigo
        • asymmetric hearing loss
    • Migraine-associated vertigo
      • differentiating factors
        • headache is usually present with migraine
  • Treatment
    • Conservative and lifestyle
      • dietary modification
        • indications
          • part of management of Meniere disease
        • modalities
          • decreased salt, coffeine, monosodium glutamate (MSG), stress, and alcohol intake
    • Medical and pharmacologic
      • vestibular suppressants
        • indications
          • used in acute vertigo episodes
        • medications
          • benzodiazepines
          • antihistamines (e.g., meclizine)
          • antiemetics
            • to manage associated nausea and vomiting
      • diuretic therapy
        • indications
          • to decrease endolymphathic hydrops that is not responsive to dietary modification
        • medications
          • hydrochlorothiazide
          • acetazolamide
  • Complications
    • Falls leading to head injury
    • Sensorineural hearing loss
  • Prognosis
    • Most patients have gradual hearing loss
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