ENT - Meniere's disease

Question 1

What is the triad of Meniere’s disease

Answer 1

Hearing loss
Vertigo
Tinnitus

Question 2

What is the pathophysiology of Meniere’s disease?

Answer 2

Ménière’s disease is associated with the excessive build-up of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals.

This increased pressure is called endolymphatic hydrops.

Question 3

Presentation

Answer 3

Unilateral hearing loss, vertigo and tinnitus

Vertigo:

• Comes in episodes
• 20m-hours
• Not triggered by movement/posture

Sensorineural hearing loss:

• Typically fluctuates at first
• Gradually becomes more permanent
• Low frequencies first usually

Tinnitus - also typically occurs with vertigo attacks before eventually becoming more permanent

Other Sx:

• A sensation of fullness in the ear
• Unexplained falls (“drop attacks”) without loss of consciousness
• Imbalance, which can persist after episodes of vertigo resolve
• Spontaneous nystagmus (usually unilateral) during acute attack

Question 4

Diagnosis of Meniere’s disease

Answer 4

Clinical based on signs and symptoms

Refer to ENT for diagnosis

Need audiometry to assess hearing loss

Question 5

Management of Meniere’s disease

Answer 5

Acute attack STM of Sx:

• Prochlorperazine
• Antihistamines (e.g., Cyclizine, promethazine)

Prophylaxis - betahistine