Ménière's Disease

Question 1

Define Ménière’s disease

Answer 1

Recurrent episodes of tinnitus, paroxysmal vertigo

and unilateral fluctuating hearing loss

Question 2

What are the causes/risk factors of Ménière’s disease?

Answer 2

Overproduction/impaired absorption of endolymph

Question 3

What are the symptoms of Ménière’s disease?

Answer 3

• Vertigo
• Hearing loss
• Tinnitus
• Aural fullness
• Drop attacks

Question 4

What are the signs of Ménière’s disease?

Answer 4

• Positive Romberg’s test
• Fukuda stepping test – head turns towards affected side when marching on spot with eyes closed
• Nystagmus
• Tandem walk – unable to walk heel-to-toe in a straight line

Question 5

What investigations are carried out for Ménière’s disease?

Answer 5

• Weber’s Test/ Audiometry - unilateral sensorineural hearing loss; usually low-frequency hearing loss is present in early stages of MD and during or before attacks; as disease progresses, middle and high frequencies are affected.
• Speech Audiometry - SRT measures the threshold (50% correct response) for a series of simple, everyday bisyllabic words such as keyboard, football, and pavement. No discrepancies on speech recognition threshold (SRT), absence of positive roll-over index.
• Tympanometry/Immitance/Stapedial Reflex Levels - immittance evaluation including tympanometry stapedial reflex measurements (both ipsilateral and contralateral) and measurement of acoustic reflex decay. Normal tympanogram; elicitation of acoustic reflex <60 dB patient threshold; no abnormal reflex decay.
• Oto-Acoustic Emissions (OAE) - absence of measurable OAE in frequency range affected by MD.
• Electrocochleography - measures electrical potentials that are derived from the hair cells in the cochlea and the auditory nerve. Abnormally large summating potential amplitude relative to the action potential amplitude.
• Eectronystagmography - records eye movements and responses to ocular and vestibular stimuli.
- Anormal in MD; unilateral decreased vestibular response in the affected ear is common.
• Vestibular-Evoked Myogenic Potential (VEMP) - VEMP uses an intense, brief auditory stimulus to assess the saccule ipsilateral to the stimulus. Increased amplitude in early disease; attenuated or absent in later stages.
• MRI to rule out other causes.