Meniere's disease

Question 1

What is the cause?

Answer 1

Unknown

Question 2

Pathophysiology?

Answer 2

There is excessive pressure and progressive dilation of the endolymphatic system

Question 3

Symptoms?

Answer 3

• recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
• a sensation of aural fullness or pressure is now recognised as being common
• other features include nystagmus and a positive Romberg test

Question 4

How long do episodes last?

Answer 4

Minutes to hours

Question 5

Are symptoms unilateral or bilateral?

Answer 5

Typically symptoms are unilateral but bilateral symptoms may develop after a number of years

Question 6

Natural history?

Answer 6

• symptoms resolve in the majority of patients after 5-10 years
• the majority of patients will be left with a degree of hearing loss
• psychological distress is common

Question 7

Management for acute attacks?

Answer 7

Buccal or intramuscular prochlorperazine. Admission is sometimes required.

Question 8

Prevention?

Answer 8

Betahistine and vestibular rehabilitation exercises may be of benefit

Question 9

What is needed to confirm diagnosis?

Answer 9

ENT assessment

Question 10

What should be done in regards to the DVLA?

Answer 10

Patients should inform the DVLA and should cease driving until satisfactory control of symptoms is achieved