Ménière syndrome

Question 1

Causes

Answer 1

This is caused by a build-up of endolymph.

Commonest in 30–50 age group

Question 2

Triad

Answer 2

Characterised by paroxysmal attacks of:

vertigo + nausea & vomiting + tinnitus + sensorineural deafness (progressive / low tones)

–Also sweating and pallor

Question 3

Clinical features

Answer 3

Abrupt onset—patient may fall

Head movements avoided—often bedridden for 1– 2 hours

Attacks last 30 mins to several hours

There is a variable interval between attack

• twice a month to twice a year

Nystagmus is observed only during an attack

• often to side opposite affected inner ear and later away from it)

Question 4

Examination

Answer 4

Sensorineural deafness (low tones)

Caloric test: impaired vestibular function

Audiometry:

• sensorineural deafness
• loudness recruitment

Special tests

Note: Tends to be overdiagnosed.

Question 5

Diagnosis is established by

Answer 5

characteristic changes in electrocochleography

Question 6

Acute attack treatment

Answer 6

Anticipation of attack (fullness, tinnitus):

• prochlorperazine 25 mg suppository or
• 30 g urea crystals in orange juice (preferably 30 minutes before in prodromal phase)

Treatment: diazepam 5 mg IV ± prochlorperazine 12.5 mg IM.

Consider betahistine 8 mg (o) tds if persistent or episodic

Question 7

Long term treatment

Answer 7

Reassurance with a very careful explanation of this condition to the patient who often associates it with malignant disease

The aim is to reduce endolymphatic pressure by reducing the sodium and water content of the endolymph.

• avoid excess intake of salt, tobacco and coffee
• A low-salt diet is the mainstay of Rx

Alleviate abnormal anxiety by:

• using stress management
• meditation or
• possibly long-term sedation (fluid builds up with stress)

Referral for neurological assessment

Diuretic, check U&Es regularly e.g.

• hydrochlorothiazide
• amiloride daily
• Hygroton
• Moduretic

Consider betahistadine (Serc) 8 mg (o) 8 hrly to prevent attacks

Advise about driving.

Support groups.

Contact the local hearing association

Consider review by NZ Dizziness and Balance Centre

If ongoing severe problems / intractable cases, surgery may be an option:

• grommets or
• intratympanic medication