Menière

Ménière's disease is a chronic inner ear disorder defined by recurrent vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. It most often begins in adulthood and follows a relapsing course with variable impact on balance and hearing.

Vertigo attacks typically last 20 minutes to several hours and may be accompanied by nausea, sweating, and imbalance. Between episodes, hearing and balance can improve, though in many cases low-frequency or mid-frequency hearing loss persists and may worsen over time.

Pathophysiology is not fully understood, but the leading theory attributes symptoms to endolymphatic hydrops—excess endolymph in the inner ear that disturbs the cochlea and vestibular apparatus. Potential contributing factors include autoimmune processes, migraine, genetic predisposition, and prior infections.

Diagnosis is clinical, based on criteria such as at least two spontaneous vertigo episodes lasting 20 minutes to 12 hours, fluctuating low-frequency SNHL on audiometry, and exclusion of other causes. MRI may be used to rule out alternative conditions; endolymphatic hydrops can be inferred in specialized imaging research.

Treatment is aimed at reducing vertigo and protecting hearing. Initial measures include a low-sodium diet and diuretics (eg, hydrochlorothiazide or acetazolamide). Acute attacks are treated with vestibular suppressants and antiemetics. Refractory cases may receive intratympanic steroids or gentamicin injections; more invasive options include endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy in severe, disabling disease.

Outcomes are variable; some patients experience fewer vertigo episodes over time, while progressive hearing loss may occur in the affected ear. The condition remains chronic and currently has no cure.