Menieres

Ménière's disease, often written with the acute accent as Ménière's disease, is a disorder of the inner ear characterized by episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Attacks typically last 20 minutes to several hours and recur over months to years. Vertigo may be accompanied by nausea and imbalance.

Most patients have unilateral involvement at onset; over time some develop bilateral involvement. The disease is usually diagnosed in middle age but can occur at any age. The cause is not fully understood; possible contributors include endolymphatic hydrops, autoimmune factors, viral infections, genetic predisposition, and vascular issues.

Diagnosis is clinical, supported by audiometry showing fluctuating sensorineural hearing loss; electrocochleography, vestibular tests, and MRI can be used to exclude other causes. There is no single diagnostic test. Diagnostic criteria typically require recurrent vertigo episodes lasting 20 minutes to about 12 hours, documented hearing loss in the affected ear, and fluctuating aural symptoms.

Treatment aims to control vertigo, protect hearing, and improve quality of life. Management includes a low-sodium diet, diuretics (such as hydrochlorothiazide), vestibular suppressants during attacks, antiemetics, and intratympanic steroids. In refractory cases, intratympanic gentamicin or surgery (endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy) may be considered. Vestibular rehabilitation can help with balance.

The course is variable; some have long periods of remission, others experience disabling vertigo with progressive hearing loss. Overall prognosis ranges from good to fair, with many not becoming completely disabled. Prevalence is modest, typically affecting adults in their 40s–60s.