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Meniere's Disease
Aka: Meniere's Disease, Meniere Disease, Labyrinthine Hydrops, Endolymphatic Hydrops
- See Also
- Vertigo
- Vertigo Causes
- Sensorineural Hearing Loss
- Peripheral Causes of Vertigo
- Central Causes of Vertigo
- Vertigo Management
- Motion Sickness
- Vestibular Neuronitis
- Benign Paroxysmal Positional Vertigo
- Perilymphatic Fistula (Hennebert's Sign)
- Acute Labyrinthitis
- Bacterial Labyrinthitis (Acute Suppurative Labyrinthitis)
- HiNTs Exam (Three-Step Bedside Oculomotor Examination)
- Horizontal Head Impulse Test (Head Thrust Test, h-HIT)
- Nystagmus
- Skew Deviation (Vertical Ocular Misalignment, Vertical Heterotropia, Vertical Strabismus)
- Dix-Hallpike Maneuver
- Dizziness
- Dysequilibrium
- Syncope
- Light Headedness
- Epidemiology
- Incidence: 4.3 per 100,000 persons/year
- Prevalence: 17-46 per 100,000 persons
- Age of onset
- Most common at ages 20 to 60 years old
- Peaks at 40-60 years old
- Etiology
- Unknown
- Exacerbated by stress or emotional disturbance
- Associated with concurrent infection in 50% cases
- Pathophysiology
- Swelling of endolymphatic labyrinthine spaces (increased endolymphatic fluid pressure)
- Degeneration of the Organ of Corti
- Symptoms
- Prodrome
- Headache
- Triad
- Tinnitus
- "Roaring", low tone Tinnitus (or aural fullness)
- Vertigo
- Recurrent episodes that may last minutes to hours, days when severe (may require bed rest)
- Diagnosis requires at least 2 episodes lasting 20 minutes
- Associated Nausea, Vomiting and Ataxia
- Sensorineural Hearing Loss
- Fluctuant, typically low pitched Hearing Loss
- Distribution
- Typically unilateral, at least initially (but 33% have bilateral disease)
- Other symptoms
- Episodic fluctuating, ear pressure or aural fullness (inner ear endolymphatic fluid collection)
- Signs
- Nystagmus (and associated Ataxia)
- Nystagmus is only present when Vertigo present
- Unidirectional, horizontal or rotary, torsional Nystagmus
- Sensorineural Hearing Loss
- Early: Low tones affected (low to medium frequency Sensorineural Hearing Loss)
- Later: All tones affected
- Hyperacusis
- Some noises may seem paradoxically louder (auditory recruitment)
- Management: Acute
- Diazepam IV
- Atropine IV
- Transdermal Scopolamine
- Management: Maintenance
- Diuretics
- Hydrochlorothiazide or
- Hydrochlorothiazide/Triamterene (Dyazide)
- Lifestyle changes
- Low salt diet (<2 grams daily)
- Decrease Caffeine
- Smoking Cessation
- Limit Alcohol
- Vestibular rehabilitation or Exercises may be effective
- Symptomatic Medications for acute episodes
- See Vertigo Management for acute symptomatic management
- Vestibular balance and rehabilitation therapy
- Management: ENT
- Transtympanic injection of Corticosteroids
- Ablation of vestibular hair cells (in those who already have Hearing Loss)
- Performed with transtympanic injection of Gentamicin
- Surgery: (10% of patients with refractory cases)
- Decompress endolymphatic sacs (Symptom relief in 66%)
- Vestibular Nerve section (Symptom relief in 95%)
- No procedure corrects the Hearing Loss
- References
- Glasscock (1984) Am J Otol 5:536-42 [PubMed]
- Knox (1997) Am Fam Physician 55(4):1185-90 [PubMed]
- Muncie (2017) Am Fam Physician 95(3): 154-62 [PubMed]