Meniere's Disease

Question 1

Definition

Answer 1

Condition of inner ear = clinical syndrome
- vertigo
- fluctuating hearing loss
- tinnitus
- associated with feeling of fullness in the affected ear

Question 2

Epidemiology

Answer 2

• 20-60
• Caucasian
• FHx
• Migraines
• Autoimmune disease: SLE, RA, Ankylosing spondylitis
• Head trauma
• Viral infection

Question 3

Clinical features

Answer 3

• Vertigo - may be accompanied by N+V
• Tinnitus
• Fluctuating hearing loss
• Aural fullness: pressure in ears
• Unsteadiness on feet: persistent for several days after acute attack of vertigo
• Nystagmus: unidirectional, horizontal-torsional nystagmus
• Postive Romberg’s test

Question 4

How do symptoms present?

Question 5

Diagnosis

Answer 5

Clinical diagnosis
GOLD STANDARD: Meet Criteria
- Vertigo = lasts 20 mins to 12 hours
- Fluctuating hearing, tinnitus +/- perception of aural fullness in affected ear
- Hearing loss = sensorineural hearing loss on audiometry
Not accounted for by alternative vestibular diagnosis
Consider:
- Otoscopy
- Pure-tone audiometry
- MRI head
- Lyme disease serology
- Syphilis serology

Question 6

Treatment Acute

Answer 6

Severe, acute attacks: Prochlorperazine
= D2-receptor antagonist used to rapidly relieve nausea and vomiting in acute attacks, given either buccal or IM

Non-severe, acute attacks : consider a short course (e.g. 7 days) of the following to relieve nausea and vomiting
= Prochlorperazine
= Anti-histamine: e.g. cinnarizine, cyclizine or promethazine

Question 7

Prophylaxis

Answer 7

Betahistine: considered to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo

Question 8

Other treatment options

Answer 8

Counselling and relaxation therapy
Paitent must alert DVLA once diagnosed = DLVA will permit a licence again if Sx are in good control

Question 9

Complications

Answer 9

Anxiety
Depression
Social impact
Falls