Meniere's Disease

Idiopathic disorder causing vertigo

Aetiology

  • Thought to be caused by excess of endolymph within the membranous labryth

Pathophysiology

  • Current theories suggest the symptoms result from an increase in endolymphatic pressure due to dysfunctioning sodium channels

Clinical presentation

  • Attacks are comprised of a triad of severe paroxysmal vertigo, with sensorineural hearing loss and tinnitus on the affected side
  • Vertigo is recurrent, spontaneous, rotational vertigo with at least 2 episodes >20 mins (often lasting hours)
  • Change in hearing or tinnitus around the time of the dizzy spell
  • Sensation of ear being full

Investigations

Audiology

  • Typically low frequency sensorineural hearing loss
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Management

  • Supportive treatment during episodes
  • Tinnitus therapy
  • Hearing aids
  • Lifestyle advice - reducing salt, avoiding chocolate and caffeine, avoiding stress
  • There are some medical, injected and surgical options but not much evidence to support effectiveness