Meniere's disease

Question 1

what is meniere’s disease?

Answer 1

Meniere’s disease is a disorder affecting the inner ear which can affect balance and hearing

It is a clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss, and tinnitus and is associated with a feeling of fullness in the affected ear

Question 2

what is the pathophysiology of meniere’s disease?

Answer 2

The underlying mechanism is believed to be distortion of the membranous labyrinth resulting from overaccumulation of endolymph.

Question 3

what are the risk factors for meniere’s disease?

Answer 3

• autoimmunity
• genetic susceptibility
• metabolic disturbances
• vascular factors
• viral infection
• head trauma

Question 4

what are the complications of menieres?

Answer 4

• falls, related to imbalance, unsteadiness, and drop attacks
• psychological effects e.g anxiety and depression
• social effects e.g work issues, affect driving ability

Question 5

what are the symptoms of Meniere’s?

Answer 5

• episodes of vertigo, described as spinning or rocking, with/out nausea/vomiting.
• tinnitus
• fluctuating sensorineural hearing loss
• aural fullness

Question 6

what differentials can be considered for Meniere’s?

Answer 6

• acoustic neuroma
• multiple sclerosis
• perilymph fistula
• vascular events

Question 7

when should a patient be refered?

Answer 7

• admit if severe symptoms
• refer to ENT to confirm diagnosis
• signs of hearing loss
• involve MDT

Question 8

what self care advice can be given to someone with Meniere’s?

Answer 8

• reassure. its a long term condition but symptoms improve with treatment
• if sudden attacks of vertigo, keep medication at hand and consider risk operating heavy machinery

Question 9

What symptomatic treatment is recommended for an acute attack of Meniere’s disease?

Answer 9

• severe symptoms = hospital admission for IV labyrinthine sedatives and fluids
• for rapid relief of severe nausea and vomiting, buccal prochlorperazine or deep IM of prochlorperazine or cyclizine
• nausea and vomiting in general, consider prochloperazine or an antihistamine short course

Question 10

what can be used to prevent recurrent attacks of Meniere’s?

Answer 10

• consider trial of betahistine

- if this doesnt work, refer to ENT