Meniere disease
Meniere disease is a chronic inner-ear disorder linked to endolymphatic hydrops, causing recurrent episodic vertigo with fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Diagnosis is clinical, confirmed by audiometry; acute attacks are treated with antiemetics, and prevention relies on a low-salt diet (<2 g sodium/day) and diuretics.
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What this article covers
- Overview
Chronic inner-ear disorder: Meniere disease is a relapsing-remitting condition of the inner ear producing recurrent episodic vertigo together with fluctuating sensorineural hearing loss, tinnitus…
- Epidemiology
Onset typically in early-to-mid adulthood: symptom onset most often occurs between ages 20 and 40 years, though the disease can present outside this range.
- Risk factors
Family history: a genetic predisposition contributes to susceptibility in a subset of patients, though the disease is most often sporadic.
- Pathophysiology
Endolymphatic hydrops: excess accumulation of endolymph within the membranous labyrinth distends the endolymphatic compartment, historically considered the direct mechanical cause of episodic symptoms.
- Clinical features
Diagnostic criteria (clinical diagnosis): at least two spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours, together with fluctuating or nonfluctuating sensorineural hearing loss…
- Differential diagnosis
Benign paroxysmal positional vertigo (BPPV): brief (seconds to about 1-2 minutes), position-triggered vertigo with a positive Dix-Hallpike maneuver and no hearing loss or tinnitus, unlike the longer…
- Diagnosis
Meniere disease is diagnosed clinically by meeting the criteria of two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, plus documented fluctuating or nonfluctuating…
- Management
First, treat the acute vertiginous episode symptomatically with an antiemetic, since pharmacologic treatment of the underlying disease is otherwise of little proven value: meclizine 25-50 mg PO every…
- Complications
Progressive, eventually fixed sensorineural hearing loss: repeated episodes over years can lead to permanent hearing loss on the affected side, no longer fluctuating with attacks.
- Prognosis
Variable, relapsing-remitting course: attack frequency and severity vary widely between patients and over time within the same patient, with some achieving prolonged remission and others experiencing frequent recurrent episodes.
- Prevention
Maintain a low-sodium diet with daily sodium intake below 2 g as the primary evidence-based preventive measure, continued indefinitely once the diagnosis is established.
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