MENIERE'S DISEASE


I. Pathophysiology and clinical features
  1. Caused by fluid accumulation in the labyrinth
  2. Symptoms are intermittent and involve combination of (vertigo + tinnitus), usually with onset over minutes and lasting several hours.
  3. Sensorineural hearing loss is often also present during episodes
  4. Hearing loss usually affects low frequencies initially, though over time can include middle and high frequencies.
  5. Can start with just vertigo or just hearing loss and acquire the other symtpoms over the course of a year or so
  6. Over time, acute attacks and vertigo tend to decline in frequency, but hearing loss and tinnitus often become permanent.
  7. Usually starts as unliateral; 50% become bilateral
II. Diagnosis
  1. Audiometry
  2. MRI with and w/o contrast can help r/o acoustic neuroma
III. Management
  1. Low-sodium diet and diuretics often recommended but there is limited data to support their effectiveness
  2. "Vestibular suppressants" can help during an acute episode, e.g. meclizine, lorazepam, clonazepam, scopolamine, dimenhydrinate.
  3. "Labyrinthectomy" by chemical (intratympanic gentamicin) or surgical means can be effective but cause irreversible hearing loss on the treated side.
  4. Hearing aids or cochlear implants if needed for hearing loss
(Sources include Core Content Review of Family Medicine, 2012)