Meniere disease

Question 1

What is the cause of Meniere’s disease?

Answer 1

Distension of membranous labyrinth (endolymphatic hydrops)

Acute attacks may occur due to

• Ruptures in Reissner’s membrane 🡪 mixing of endolymph and perilymph
• Sudden release to an obstruction in endolymphatic circulation, causing vertigo 🡪 settles as inner-ear fluids stabilize again

Question 2

What are the clinical features of Meniere disease?

Answer 2

Attacks may be precipitated by 1) roaring tinnitus or 2) aural fullness in affected ear

3) Acute onset, episodic, recurrent vertigo
- Lasts for hours
- A/w N&V, horizontal nystagmus
- Disabling 🡪 remains in bed until episode has passed; feels off-balance for next few days
- Preceded by aura

4) Unilat SNHL
- Affects lower frequencies (in early stages in disease)
- Hearing returns after attack but gradual decline in hearing over many years (fluctuating)
- Occasionally manifests as drop attacks w/ no loss of consciousness and immediate recovery

Question 3

How is meniere disease managed?

Answer 3

Prevention of attacks (by preventing acute retention of water)

• Dietary modification: low salt, avoid triggers (salt, caffeine, chocolate)
• Diuretics, e.g. hydrochlorothiazide
• Vasodilators, e.g. betahistine

During active phase of attacks

• Steroids
• Vestibular sedatives e.g. cinnarizine (Stugeron) (antihistamine), prochlorperazine (Stemetil) (phenothiazine derivative) (do not continue after attack subsides)

Surgical (indicated when symptoms remain uncontrolled despite optimal medical therapy)

• Non-destructive: endolymphatic sac surgery
• Destructive: intra-tympanic gentamicin (chemical ablation), vestibular nerve section (surgical ablation), labyrinthectomy

Question 4

What is the definition of definite Meniere’s disease?

Answer 4

• 2 or more spontaneous episodes of vertigo, each lasting 20 min to 12 h
• Audiometrically documented low- to midfrequency SNHL in 1 ear, defining the affected ear on at least 1 occasion before, during, or after 1 of the episodes of vertigo
• Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
• Not better accounted for by another vestibular diagnosis