Ménière’s Disease

Question 1

What is Ménière’s disease?

Answer 1

Ménière’s disease is a long-term inner ear disorder that causes recurrent attacks of vertigo, and symptoms of hearing loss, tinnitus and a feeling of fullness in the ear.

Question 2

What is the triad of Ménière’s disease?

Answer 2

1. Hearing loss
2. Vertigo
3. Tinnitus

Question 3

Briefly describe the pathophysiology of Ménière’s disease

Answer 3

Ménière’s disease is associated with the excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals. This increased pressure of the endolymph is called endolymphatic hydrops.

Question 4

What are the clinical features of Ménière’s disease

Answer 4

The typical patient is 40-50 years old, presenting with unilateral episodes of vertigo, hearing loss and tinnitus.

Other symptoms can include:

• A sensation of fullness in the ear
• Unexplained falls (“drop attacks”) without loss of consciousness
• Imbalance, which can persist after episodes of vertigo resolve

Spontaneous nystagmus may be seen during an acute attack. This is usually in one direction (unidirectional).

Question 5

Briefly describe the vertigo of Ménière’s disease

Answer 5

Vertigo in Ménière’s disease comes in episodes. These last for 20 minutes to several hours before settling. These episodes can come in clusters over several weeks, followed by prolonged periods (often months) without vertigo symptoms. Vertigo is not triggered by movement or posture.

Question 6

Briefly describe the hearing loss of Ménière’s disease

Answer 6

Hearing loss in Ménière’s disease typically fluctuates at first, associated with vertigo attacks, then gradually becomes more permanent. It is sensorineural hearing loss, generally unilateral and affects low frequencies first.

Question 7

Briefly describe the tinnitus of Ménière’s disease

Answer 7

Tinnitus initially occurs with episodes of vertigo before eventually becoming more permanent. It is usually unilateral.

Question 8

How is Ménière’s disease diagnosed?

Answer 8

Diagnosis of Ménière’s disease is clinical, based on the signs and symptoms. It will be made by an ear, nose and throat (ENT) specialist.

Patients will need an audiology assessment to evaluate hearing loss.

Question 9

Briefly describe the management of Ménière’s disease

Answer 9

Management involves:

• Managing symptoms during an acute attack
• Prophylactic medication to reduce the frequency of attacks

Question 10

What medication is used to treat the acute attacks of Ménière’s disease?

Answer 10

For acute attacks, short-term options for managing symptoms include:

• Prochlorperazine
• Antihistamines (e.g. cyclizine, cinnarizine and promethazine)

Question 11

What medication is given for the prophylaxis of Ménière’s disease?

Answer 11

Prophylaxis is with:

• Betahistine