Menieres disease
Meniere’s Disease 🎧🌪️:
A rare, progressive inner ear disorder causing recurrent attacks of vertigo 🌀, fluctuating sensorineural hearing loss 🎧, and tinnitus 🔔 ± aural fullness.
Typically presents in middle age and can have a major impact on quality of life.
About ℹ️
- Characterised by endolymphatic hydrops 💧 (raised endolymph pressure in the inner ear).
- Classical triad: vertigo 🌀 + tinnitus 🔔 + fluctuating hearing loss 🎧.
- May progress to permanent sensorineural hearing loss ❌👂.
Aetiology 🧬
- Excess endolymph production / impaired absorption.
- Possible autoimmune 🤒, viral 🦠, or genetic 👪 predisposition.
Clinical Features 👀
- Recurrent vertigo 🌀 (20 mins – 24 hrs).
- Fluctuating tinnitus 🔔 (often roaring/ringing).
- Progressive unilateral SNHL 🎧 (may → bilateral).
- Aural fullness/pressure 👂.
- Onset usually in middle age 👵, unpredictable course.
Diagnostic Criteria 🧾
- Vertigo 🌀: ≥2 spontaneous episodes, each lasting 20 mins–24 hrs.
- Tinnitus 🔔 / aural fullness 👂: Patient perception during attacks.
- Hearing loss 🎧: Audiometry confirms sensorineural pattern.
Stages of Disease 📊
- Early 🟢: Sudden vertigo attacks, fluctuating hearing, tinnitus, aural fullness.
- Middle 🟡: Vertigo persists, hearing loss more constant, tinnitus worsens.
- Late 🔴: Permanent hearing loss, chronic imbalance 🤸♂️ (esp. in dark), tinnitus persists.
Differentials 🔍
- BPPV 🎢 (brief vertigo, seconds).
- Vestibular migraine 🤯.
- Vestibular schwannoma 🎧🎗️.
- Labyrinthitis / vestibular neuritis 🦠.
- Autoimmune inner ear disease 🧬.
Investigations 🧪
- Audiometry 🎧: Fluctuating SNHL.
- MRI 🧲: Exclude acoustic neuroma.
- Vestibular tests ⚖️: Show unilateral hypofunction.
Management 💊
- ENT referral 👨⚕️: Formal audiology & diagnosis confirmation.
- Acute 🆘:
- Prochlorperazine 💊, cinnarizine, cyclizine, or promethazine for vertigo/nausea 🤢.
- Severe attacks → IV sedatives + fluids 💉.
- Long-term 🌿:
- Betahistine 💊: Can reduce frequency/severity.
- Avoid triggers ☕🍷🧂 (caffeine, alcohol, excess salt).
- Self-care 🏠: vertigo precautions, avoid driving 🚗 during frequent attacks.
- Support ❤️: Tinnitus counselling, hearing aids, psychological support.
References 📚
💡 Clinical Pearls
- Triad 🌀🔔🎧 = Ménière’s until proven otherwise.
- Vertigo much longer (20 mins–hours ⏱️) than BPPV (seconds ⏲️).
- Late disease: hearing loss + imbalance persist, even if vertigo settles.
