Menièren

Ménière’s disease, also known as Ménière disease, is a disorder of the inner ear characterized by episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and a feeling of fullness or pressure in the affected ear. Attacks typically last from 20 minutes to several hours and can be recurring, affecting balance and quality of life. The condition usually begins in one ear, but may become bilateral in some individuals over time.

Pathophysiology and causes: Ménière’s disease is associated with endolymphatic hydrops, an abnormal buildup of fluid in the inner ear’s endolymphatic system. The exact cause is unknown, but a combination of genetic susceptibility, autoimmune factors, migraines, infections, and vascular or inflammatory processes has been proposed. Triggers for attacks may include stress, fatigue, caffeine, alcohol, and salt intake changes, though evidence is variable.

Diagnosis: Diagnosis is clinical, based on the history of recurrent vertigo episodes and fluctuating hearing loss, with supporting audiometric testing showing low-frequency sensorineural loss in affected ears. Diagnostic criteria of specialist societies emphasize vertigo episodes lasting 20 minutes to 12 hours, fluctuating aural symptoms, and documented hearing loss on the affected side. Imaging, such as MRI with specific protocols, may be used to exclude other causes and can reveal endolymphatic hydrops in some cases but is not required for diagnosis.

Management: There is no cure. Management aims to reduce vertigo, protect hearing, and improve function. Approaches include dietary sodium restriction and diuretics, which may lessen fluid-related symptoms; intratympanic steroids or gentamicin to control vertigo; vestibular rehabilitation and avoidance of triggering factors. For refractory vertigo, procedures such as endolymphatic sac decompression or, in severe cases with profound hearing loss, labyrinthectomy or cochlear implantation may be considered. The prognosis is variable, with some individuals experiencing gradual hearing decline and others having periods of remission.