Ménière's disease

Question 1

What is Ménière’s disease ?

Answer 1

An episodic auditory and vestibular disease characterised by sudden onset of vertigo (feeling like you or everything around you is spinning), hearing loss, tinnitus (hearing ringing or buzzing), and sensation of fullness in the affected ear. 

Question 2

Describe the aetiology of Ménière’s disease

Answer 2

Aetiology → idiopathic, viral infections, autoimmunity, allergies, injuries, genetic disorders

Caused by impaired endolymph resorption in the inner ear → excess fluid in inner ear

Question 3

What are the risk factors for Ménière’s disease?

Answer 3

positive family history, recent viral illness, autoimmune disorders

Question 4

What are the presenting symptoms/ signs of Ménière’s disease?

Answer 4

• Vertigo → recurrent episodes of spinning sensations lasting minutes to hours. Usually associated with N&V. Attacks cluster in groups.
• Hearing Loss → worsens during or around the vertigo spells. Unilateral in affected ear.
• Tinnitus → unilateral in affected ear
• Aural Fullness
• Triad: recurrent episodes vertigo + hearing loss + tinnitus
• Fukuda’s Stepping Test (repetitive walking on the spot while blindfolded- Individuals with unilateral dysfunction were noted to rotate to the side of the unilateral deficit.)
• Nystagmus (repetitive uncontrolled movements in eye)
• Positive Romberg’s Test → falling when asked to stand with feet together and eyes closed

Question 5

What is virtigo?

Answer 5

Spinning sensation of oneself/ surroundings

Question 6

what is tinnitus

Answer 6

the perception of sound that does not have an external source

Question 7

What investigations are used to diagnose/ monitor Ménière’s disease ?

Answer 7

1. Pure-tone Audiometry → unilateral sensorineural hearing loss
   - Rinne’s Test ⇒ air conduction > bone conduction bilaterally (ie. positive test)
   - Weber’s Test ⇒ localises to contralateral ear
2. Speech Audiometry
3. CT/ MRI

Question 8

How is Ménière’s disease managed?

Answer 8

1. Acute Attacks ⇒ buccal/IM prochlorperazine
2. Prevention (reduce frequency of attacks) ⇒ betahistine
3. Maintenance Therapy → low salt diet & Thiazide diuretics (reduce volume of endolymph)

Question 9

What complications may arise from Ménière’s disease?

Answer 9

• Falls 
• Profound hearing loss