Meniere

Menière's disease is a disorder of the inner ear characterized by recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. It is named after Prosper Ménière, who first described the condition in the 19th century.

The underlying cause is not fully understood, but the leading hypothesis is endolymphatic hydrops—abnormal accumulation of endolymph in the inner ear. Contributing factors may include genetic susceptibility, autoimmune processes, viral infections, migraine, and vascular events. The condition typically begins in adulthood, most often in the 40s to 60s.

Symptoms include vertigo spells lasting 20 minutes to several hours, sometimes with nausea or vomiting, unsteadiness, and nystagmus. Between attacks, patients may notice a persistent, mild to moderate level of dizziness. Tinnitus is usually low-pitched, and aural fullness or pressure is common. Hearing loss tends to fluctuate early and may become permanent in the affected ear over time.

Diagnosis is clinical, supported by audiometry showing fluctuating unilateral sensorineural hearing loss and vestibular testing. MRI is used to exclude retrocochlear pathology such as vestibular schwannoma. The differential diagnosis includes vestibular migraine, benign paroxysmal positional vertigo, and other causes of vertigo.

Management aims to reduce vertigo, preserve hearing, and improve quality of life. Dietary measures (low-sodium diet, caffeine restriction) and diuretics (e.g., hydrochlorothiazide or acetazolamide) may lessen fluid pressure. During attacks, vestibular suppressants and antiemetics are used. Intratympanic steroids can help some patients; intratympanic gentamicin is considered for refractory vertigo. Refractory unilateral disease may be treated with endolymphatic sac decompression, vestibular nerve section, or, rarely, labyrinthectomy. Hearing loss can be aided with amplification or cochlear implants if needed.

Prognosis varies. Attacks may recur for years; some remission occurs. Progressive hearing loss can occur, and the condition can affect balance and quality of life. The disorder affects a small portion of the population, with onset most common in middle age.