Updated: 12/11/2019

Meniere Disease

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
4
0
0
0%
0%
Evidence
4
0
0
Topic
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
  • Prognosis
    • most patients have gradual hearing loss
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

Please rate topic.

Average 4.6 of 5 Ratings

Questions (4)

(M2.OMB.18.1) A 56-year-old woman presents to her primary care physician for dizziness. She says that her symptoms began approximately 1 month prior to presentation and are associated with nausea and ringing of the ears. She describes her dizziness as a spinning sensation that has a start and end and lasts approximately 25 minutes. This dizziness is severe enough that she cannot walk or stand. Her symptoms are fluctuating, and she denies any tunnel vision or feelings of fainting. However, she has abruptly fallen to the ground in the past and denied losing consciousness. Medical history is significant for a migraine with aura treated with zolmitriptan, type 2 diabetes managed with metformin, and hypertension managed with lisinopril. Her blood pressure is 125/75 mmHg, pulse is 88/min, and respirations are 16/min. On physical exam, when words are whispered into her right ear, she is unable to repeat the whispered words aloud; however, this is normal in the left ear. Air conduction is greater than bone conduction with Rinne testing, and the sound of the tuning fork is loudest in the left ear on Weber testing. Which of the following is most likely the diagnosis? Tested Concept

QID: 210758
1

Benign paroxysmal positional vertigo

50%

(1/2)

2

Meniere disease

50%

(1/2)

3

Migraine

0%

(0/2)

4

Transient ischemic attack

0%

(0/2)

5

Vestibular neuritis

0%

(0/2)

M 6 C

Select Answer to see Preferred Response

(M2.ET.17.4694) A 45-year-old male presents to his primary care physician for complaints of dizziness. The patient reports he experiences room-spinning dizziness lasting several hours at a time, approximately 2-3 times a month, starting 3 months ago. Upon questioning, the patient also reports right sided diminished hearing, tinnitus, and a sensation of ear fullness. Her temperature is 99 deg F (37.2 deg C), pulse 70/min, respirations 12, blood pressure 130 mmHg/85 mmHg, SpO2 99%. You decide to order an audiometric evaluation. What is the most likely finding of the audiogram? Tested Concept

QID: 107749
1

Low frequency sensorineural hearing loss

20%

(1/5)

2

High frequency sensorineural hearing loss

60%

(3/5)

3

Low frequency conductive hearing loss

0%

(0/5)

4

High frequency conductive hearing loss

20%

(1/5)

5

Normal audiogram

0%

(0/5)

M 6 C

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M3.ET.13.16) A 56-year-old woman presents to the emergency department with several episodes in which she felt "dizzy." She has had these symptoms on and off for the past year and can recall no clear exacerbating factor or time of day when her symptoms occur. She has a perpetual sensation of fullness in her ear but otherwise has no symptoms currently. Her temperature is 97.6°F (36.4°C), blood pressure is 122/77 mmHg, pulse is 85/min, respirations are 13/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is unremarkable. The patient's gait is stable. Which of the following is also likely to be found in this patient? Tested Concept

QID: 102615
1

Conductive hearing loss

0%

(0/4)

2

Gradually improving symptoms

0%

(0/4)

3

Positional vertigo

75%

(3/4)

4

Sensorineural hearing loss

25%

(1/4)

5

Vertical nystagmus

0%

(0/4)

M 10 E

Select Answer to see Preferred Response

Evidence (4)
EXPERT COMMENTS (2)
Private Note