Related to this topic: Leaflets | Support | UK Guidelines | Weblinks | Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Meniere's Disease
This is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. The membranous labyrinth is necessary for hearing and balance and is filled with endolymph. An increase in endolymph can cause the membranous labyrinth to dilate - endolymphatic hydrops. This leads to rupture of the endolymph membrane and mixing of endolymph and perilymph, which causes the symptoms of Menieres; disturbed hearing and positional sense. Between attacks, there is pressure-dependent loss of cochlear and vestibular neurones with distortion of structures of the labyrinth.1,2
The condition is diagnosed on the basis of the following three factors:
|
It is usually idiopathic, but rarely may be caused by labyrinthitis due to viral/bacterial infection or trauma, eg temporal bone fracture. Recent research has shown that autoimmunity and the anti-phospholipid syndrome may have a role.3
Prevalence
Estimates vary due to differing diagnostic criteria. 1 in 1,000 to 1 in 20,000 population.4,5
- Mainly affects patients aged 20-50 years.
- Equal male and female incidence.
- In about 8% of cases it is a familial condition with uncertain patterns of inheritance.6
- The condition is rare in children.
Symptoms
All three should be present:
- Paroxysmal vertigo, normally lasting 20 mins - 24 hours, often with nausea and nystagmus. At least two episodes of vertigo lasting >20 mins are required to fulfil the diagnostic criteria.
- Fluctuating sensorineural hearing loss. Usually low frequency loss predominates.
- Tinnitus (usually low tone with blowing character) and/or subjective feeling of fullness in the ear. Rarely accompanied by vestibular drop attacks.
Signs
There are no confirmatory signs but cardiovascular and neurological examination are advisable to look for other causes of similar symptoms.
Hallpike's manoeuvre is used to diagnose benign paroxysmal positional vertigo (BPPV)
- Benign paroxysmal positional vertigo (BPPV). Clinical diagnosis made by response to head movement tests.7
- Vertigo associated with migraine
- Drug reactions
- Otitis media or externa
- Labyrinthitis or vestibular neuronitis
- Ischaemic disease of vertebrobasilar system
- Functional or psychological illness
- Labyrinthine fistula
- Acoustic neuroma
- Medical conditions such as autoimmunity, hypothyroidism and anaemia can sometimes mimic Meniere's
- Cerebellar disease
- Cogan's syndrome8
- Neurosyphilis
Audiometry confirms the classical pattern of sensorineural hearing loss.
Further investigations such as neuroimaging will depend on the degree of suspicion of other pathology.
Electrocochleography (ECOG) and electronystagmography (ENG) are sometimes used in specialist investigation.9
The aim of therapy is to:
- Alleviate acute attacks
- Reduce severity and frequency of attacks
- Improve hearing and reduce the impact of tinnitus
Drugs
- Acute attacks; vertigo and nausea can be alleviated by prochlorperazine and cinnarizine.
- Prophylaxis; usually use betahistine or diuretics.10 There is little evidence for the effectiveness of these treatments, with the possible exception of betahistine.11 Response to prophylactic agents varies between individuals, so it is worth trying different drugs until a satisfactory response is achieved. Their mode of action is uncertain.
Surgical
Approximately 20% of cases are severe and uncontrolled by medication. These patients may need an ablative procedure to manage their vertigo, which can be medical (local gentamicin12) or surgical. They aim to selectively destroy balance receptors, while preserving cochlear function (hearing).
Supportive measures
- A low salt diet may be beneficial.13
- Hearing aids tailored to pattern of hearing loss.
- Avoidance of loud noise to which there may be intolerance.
- Sound therapy and relaxation/distraction techniques for tinnitus. See internet section below for helpful patient information.
- After an acute attack of vertigo, patients naturally tend to sit still. Encourage them to move around to promote central compensation, where the brain uses vision and other senses to compensate for the loss of vestibular function.
- Loss of driving licence, if symptoms are sudden and disabling.14
- Quality of life can be severely affected in some people because of the unpredictable, and progressive nature of the condition.
- Anxiety and depression.
Usual disease course has 3 stages15:
- Early; predominantly vertigo attacks which are sudden and unpredictable. Hearing worsens and tinnitus increases. Returns to normal when attack is over.
- Middle; progressive lower pitch sensorineural hearing loss. Vertigo at its worst. Tinnitus also progresses. May have periods of remission of several months.
- Late-stage; progressively deteriorating hearing loss. General balance problems develop, especially in the dark, but vertigo lessens. Tinnitus is significant.
Document References
- PRODIGY; Meniere's Disease (2003)
- Lorenzo N. Meniere disease; eMedicine, July 2006
- Mouadeb DA, Ruckenstein MJ; Antiphospholipid inner ear syndrome. Laryngoscope. 2005 May;115(5):879-83. [abstract]
- Bandolier. Meniere's Disease; 1995
- Bandolier. Tinnitus and Meniere's update; April 2000
- Bachor E, Karmody CS; Endolymphatic hydrops in children. ORL J Otorhinolaryngol Relat Spec. 1995 May-Jun;57(3):129-34. [abstract]
- Swartz R, Longwell P. American Family Physician. Treatment of Vertigo (good clinical overview article with images of diagnostic and therapeutic manoeuvres for BPPV).; March 2005
- American Hearing Research Foundation Cogan's syndrome; definition and details (ocular keratitis with Meniere's-like symptoms)
- Kim HH, Wiet RJ, Battista RA; Trends in the diagnosis and the management of Meniere's disease: results of a survey. Otolaryngol Head Neck Surg. 2005 May;132(5):722-6. [abstract]
- Claes J, Van de Heyning PH; A review of medical treatment for Meniere's disease. Acta Otolaryngol Suppl. 2000;544:34-9. [abstract]
- Mira E, Guidetti G, Ghilardi L, et al; Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. Eur Arch Otorhinolaryngol. 2003 Feb;260(2):73-7. Epub 2002 Sep 11. [abstract]
- Assimakopoulos D, Patrikakos G; Treatment of Meniere's disease by intratympanic gentamicin application. J Laryngol Otol. 2003 Jan;117(1):10-6. [abstract]
- Thai-Van H, Bounaix MJ, Fraysse B; Meniere's disease: pathophysiology and treatment. Drugs. 2001;61(8):1089-102. [abstract]
- DVLA; Medical standards for drivers
- Saeed SR; Fortnightly review: Diagnosis and treatment of Meniere's disease; BMJ January 1998
Internet and Further Reading Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2449
Document Version: 20
DocRef: bgp944
Last Updated: 30 May 2007
Review Date: 29 May 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicine
View patient experiences and discussions about this condition / medicine (62 there)Information leaflets related to this topic (^ top of page)
Ménière's DiseasePatient Support related to this topic (^ top of page)
Ménière's SocietyUK guidelines related to this topic (^ top of page)
Guidelines on Meniere's DiseaseLinks to other selected websites related to this topic (^ top of page)
Ménière's DiseaseOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)

Books related to this topic (^ top of page)

Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
