Ménière's disease

Background

  • Occurs due to increased endolymph within the cochlea and labyrinth (endolymphatic hydrops)
  • First attack usually occurs in patients >65yrs
  • Usually is unilateral but may become bilateral with time

Clinical Features

  • Episodes of sudden-onset vertigo with nausea/vomiting
    • Can include "drop attacks" where the patient feels knocked to the ground
    • Duration: usually 2-8hr
    • Frequency: Ranges from several episodes per week to several times per month
  • Roaring tinnitus
  • Diminished hearing
  • Fullness in affected ear
  • Between attacks patient is well (although decreased hearing and constant tinnitus may persist)

Differential Diagnosis

Vertigo

Evaluation

  • No workup required for classical Meniere disease in the ED
  • Confirmed by ENT via glycerol testing or vestibular-evoked potentials
  • Imaging with MRI if suspicion or need to rule out lesions such as[1]:

Management

Disposition

  • Refer to ENT for further evaluation and management
  • Surgery may include vestibular nerve section (surgical or chemical), endolymph sac decompression, endolymphatic-subarachnoid shunt, or labyrinthectomy

References

  1. ↑ Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. 2000 Aug. 120(5):615-9.
  2. ↑ Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.
  3. ↑ Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. 2002 Jun. 35(3):581-9, vii.
  4. ↑ Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. 2010 Jan 20. CD005395.
  5. ↑ Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. 2004 Oct. 37(5):955-72, v.
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