Meniere’s disease: a primer

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For a more complete and thorough review, you are referenced to Lancet 372 2008

This disorder is a chronic illness that affects many people every year worldwide. It has been described since 1861! There are specific characteristics. Patients experience intermittent (not constant) episodes of vertigo lasting from minutes to hours, their hearing fluctuates (specifically sensorineural hearing), there is ringing of the ear(s) (tinnitus), and ear pressure sensation.

Even though there is currently no cure, more than 85% of those with Meniere’s are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures. Some of these procedures can be done in the office. Some do require more specialized surgery.

Such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness.

In 1927, scientist discovered the endolymphatic sac as the site of “outflow of endolymph” in guineapigs. This provided insight into the mechanics of endolymphatic flow in the inner ear. In 1967, scientists showed that blockage of the endolymphatic sac and duct causes obstruction of endolymphatic outflow, leading to hydrops of the inner ear.

Despite this knowledge, Meniere’s disease remains a difficult disease to diagnose! Patients may present to the emergency department in early stages with only cochlear symptoms such as hearing loss and pressure or fullness in the ear without true vertigo or even ringing in the ears. It is found more common in adults in their fourth and fifth decade. A strong positive family history can exist in patients with Meniere’s disease.

Meniere’s disease symptoms include intermittent episodes of vertigo lasting from minutes to hours (20 minutes to 12 hours), with fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Most have one sideded symptoms,with the rate of bilateral disease to be as high as 50% after many years. It remains a clinical diagnosis; a diagnosis of exclusion. A detailed history and a complete physical examination are necessary. Any specific testing and imaging should be directed by knowledgeable planning to avoid expensive and unnecessary testing. Up-sloping low-frequency sensorineural hearing loss that fluctuates is noted on audiometric testing. A conductive loss can at times be seen.Symptoms can be aggravated by consumption of caffeine, chocolate, alcohol, and salt. Food allergies should be investigated, treated and avoided as much as possible. Salt intake should be maximum of 2 g per day, Diuretics such as a combination of hydrochlorothiazide and triamterene can be beneficial. Those allergic to sulpha could use acetazolamide or chlorthalidone. Steroids in the form of oral, intramuscular, intravenous, and intra-tympanic have been utilized in a beneficial manner for some. Destructive treatments can be used in patients with intractable vertigo. Gentamicin is one such agent, affecting both vestibular (balance) and cochlear (hearing) function. If the ear affected is a non-hearing hear, this may be a good option (ie, speech reception threshold worse than 50 db and speech discrimination score of less than 50%).

Pressure pulse treatment by the Meniett device may help some but the long-term efficacy is reportedly poor. Endolymphatic sac surgery is more invasive but considered an effective procedure for symptomatic Meniere’s disease. Vestibular nerve section is offered in specialized centers for intractable vertigo.

Non-surgical treatment can involve vestibular rehabilitation.

You can learn more about this topic by looking to this article:

H. Sajjadi, M.M. Paparella
Meniere’s disease
Lancet, 372 (2008), pp. 406–414
If you have questions regarding ear disease or nose, throat, cancer, sleep surgery, thyroid / parathyroid, please call. ENT is trained in 7 core areas over a 5 year residency after medical school: allergy, facial plastic and reconstructive surgery, head and neck, laryngology, otology, pediatric otolaryngology, and rhinology. We are the only surgical specialty dedicated solely to this area.
Philip Harris, M.D. FACS
MidMichigan Physicians Group
Midland / Gladwin / Bay City
Phone (989) 839-6201


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