Meniere's Disease

Aka: Meniere's Disease, Labyrinthine Hydrops, Endolymphatic Hydrops

1. Etiology
   1. Unknown
   2. Exacerbated by stress or emotional disturbance
   3. Associated with concurrent infection in 50% cases
2. Pathophysiology
   1. Swelling of endolymphatic labyrinthine spaces
   2. Degeneration of the organ of Corti
3. Symptoms
   1. Prodrome
      1. Headache
   2. Triad
      1. Tinnitus: "Roaring", low tone
      2. Vertigo: Recurrent episodic
      3. Sensorineural Hearing Loss: fluctuant
   3. Usually unilateral
      1. But 33% have bilateral disease
   4. Dizziness
      1. May last minutes to hours, days when severe
4. Signs
   1. Nystagmus
      1. Only present when Vertigo present
   2. Sensorineural Hearing Loss
      1. Early: Low tones affected
      2. Later: All tones affected
5. Management: Acute
   1. Diazepam IV
   2. Atropine IV
   3. Transdermal Scopolamine
6. Management: Maintenance
   1. Medications
      1. Diazepam
      2. Bellergal
      3. Meclizine
   2. Low salt diet (<2 grams daily)
   3. Decrease caffeine
   4. Smoking Cessation
   5. Diuretics (Dyazide)
7. Management: ENT
   1. Ablation of vestibular hair cells
      1. Performed with intratympanic injection of Gentamicin
   2. Surgery: (10% of patients with refractory cases)
      1. Decompress endolymphatic sacs (Symptom relief in 66%)
      2. Vestibular nerve section (Symptom relief in 95%)
      3. No procedure corrects the Hearing Loss
8. References
   1. Glasscock (1984) Am J Otol 5:536-42
   2. Knox (1997) Am Fam Physician 55(4):1185-90