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 ETIOLOGY 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