Ménière's disease

Question 1

Define Meniere’s disease.

Answer 1

… is an auditory disease characterised by
* an episodic sudden onset of vertigo,
* low-frequency hearing loss (in the early stages of the disorder),
* low-frequency roaring tinnitus,
* and sensation of fullness in the affected ear.

Question 2

How common is Meniere’s?

Answer 2

15 per 100,000

Question 3

What are the risk factors for Meniere’s?

Answer 3

• recent viral infection
• genetic predisposition
• autoimmune disease

Question 4

What is the pathophysiology of Meniere’s?

Answer 4

?over-production or under absorption of lymphatic endolymph

?excessive endolymphatic fluid pressure causing distension and rupture of Reissner’s membrane

?immune mediated

Question 5

What are the clinical features of Meniere’s?

Answer 5

• vertigo
• hearing loss
• tinnitus
• aural fullness
• drop
• positive Romberg’s test
• Fukuda’s stepping test
• bilateral symptoms
• nystagmus - horizontal +/- rotary during accute attacks, supressed by visual fixation
• tandem walk (unable to heel to toe)

Question 6

What is Fukuda’s stepping test?

Answer 6

Turning towards the affected side when asked to march in place with eyes closed.

Question 7

What is the prognosis with Meniere’s?

Answer 7

• symptoms resolve in the majority of patients after 5-10 years
• the majority of patients will be left with a degree of hearing loss
• psychological distress is common

Question 8

What is the management of Meniere’s?

Answer 8

Investigations:
* ENT assessment is required to confirm the diagnosis
* pure-tone audiometry - sensorineural hearing loss, low freqency first then medium and high Hz tones affected
* vestibular testing
* MRI gandolium - done for any patient with asymmetrical hearing loss, excl acoustic neuroma

patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved

Treatment:
* acute attacks: buccal or intramuscular prochlorperazine.
* admission sometimes required
* prevention: betahistine and vestibular rehabilitation exercises

Question 9

What disunguished vestibular mifraine and vestibular neuronitis from Meniere’s?

Answer 9

Vestibular neuronitis =
Neural degeneration or viral infection of the eighth nerve can produce acute or chronic vertigo, nausea, and vomiting. There is no hearing loss, tinnitus, or aural fullness.

Vestibular migraine =
Much overlap and may coexist but very short (<15 minutes) or prolonged (>24 hours) durations of vertigo suggests migraine, and visual auras are more likely. Hearing loss is usually mild and stable over time.

Question 10

What are the main complications of Meniere’s?

Answer 10

Falls
Profound hearing loss in 1-6%