Vstblr

Meniere's Disease

search

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

  • Epidemiology
  1. Incidence: 4.3 per 100,000 persons/year
  2. Prevalence: 17-46 per 100,000 persons
  3. Age of onset
    1. Most common at ages 20 to 60 years old
    2. Peaks at 40-60 years old
  • Etiology
  1. Unknown
  2. Exacerbated by stress or emotional disturbance
  3. Associated with concurrent infection in 50% cases
  • Pathophysiology
  1. Swelling of endolymphatic labyrinthine spaces (increased endolymphatic fluid pressure)
  2. Degeneration of the Organ of Corti
  • Symptoms
  1. Prodrome
    1. Headache
  2. Triad
    1. Tinnitus
      1. "Roaring", low tone Tinnitus (or aural fullness)
    2. Vertigo
      1. Recurrent episodes that may last minutes to hours, days when severe (may require bed rest)
      2. Diagnosis requires at least 2 episodes lasting 20 minutes
      3. Associated Nausea, Vomiting and Ataxia
    3. Sensorineural Hearing Loss
      1. Fluctuant, typically low pitched Hearing Loss
  3. Distribution
    1. Typically unilateral, at least initially (but 33% have bilateral disease)
  4. Other symptoms
    1. Ear pressure or aural fullness (inner ear endolymphatic fluid collection)
  • Signs
  1. Nystagmus
    1. Nystagmus is only present when Vertigo present
    2. Unidirectional, horizontal or torsional Nystagmus
  2. Sensorineural Hearing Loss
    1. Early: Low tones affected (low to medium frequency Sensorineural Hearing Loss)
    2. Later: All tones affected
  • Management
  • Acute
  1. Diazepam IV
  2. Atropine IV
  3. Transdermal Scopolamine
  • Management
  • Maintenance
  1. Diuretics
    1. Hydrochlorothiazide or
    2. Hydrochlorothiazide/Triamterene (Dyazide)
  2. Lifestyle changes
    1. Low salt diet (<2 grams daily)
    2. Decrease Caffeine
    3. Smoking Cessation
    4. Limit Alcohol
    5. Vestibular rehabilitation or Exercises may be effective
  3. Symptomatic Medications for acute episodes
    1. See Vertigo Management
  • Management
  • ENT
  1. Ablation of vestibular hair cells (in those who already have Hearing Loss)
    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