Makindo Medical Notes

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 📚

• NICE Guidance on Ménière’s Disease

💡 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.