Ménièren

Ménière's disease is a disorder of the inner ear that presents with recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. It typically begins in adulthood, most often between the ages of 20 and 60, and can affect one ear initially though both ears may be involved over time. The condition is considered chronic and episodic, with varying intervals between attacks.

Signs and symptoms include vertigo that lasts from 20 minutes to several hours, sometimes up to 24 hours, accompanied by nausea or vomiting. Hearing loss is usually fluctuating and most pronounced in the low to mid frequencies, and may become more permanent with time. Tinnitus and a feeling of fullness or pressure in the affected ear are common. Some individuals experience sensitivity to sound and motion sickness during episodes. Between attacks, many patients have normal function or mild residual symptoms.

Pathophysiology and causes are not fully understood. The leading hypothesis centers on endolymphatic hydrops—an abnormal buildup of fluid in the inner ear’s endolymphatic system. Interactions among genetic predisposition, autoimmune factors, viral infections, migraines, and environmental triggers are under investigation, but no single cause accounts for all cases.

Diagnosis is clinical and supported by audiometric testing. The American Academy of Otolaryngology–Head and Neck Surgery criteria emphasize recurrent vertigo, fluctuating hearing loss, and tinnitus or ear fullness. Imaging, particularly MRI, is used to exclude other inner-ear or central causes.

Treatment focuses on reducing vertigo and protecting hearing. Lifestyle measures such as a low-sodium diet, caffeine and alcohol restriction, and smoking cessation may help. Medications include diuretics (e.g., hydrochlorothiazide or acetazolamide) and vestibular suppressants during attacks. Intratympanic applications of steroids or gentamicin can be considered for refractory vertigo. Surgical options (endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy) are for severe, intractable cases. Prognosis is variable; some experience fewer episodes over time, while others may progress to persistent hearing loss. The condition is named after Prosper Ménière, who first described the syndrome in 1861.