Menieres disease

Question 1

What is meniere’s disease?

Answer 1

Meniere’s disease is a condition of the inner ear
- It is characterised by vertigo, unilateral fluctuating hearing loss, tinnitus, and fullness of the ear

Question 2

What are the risk factors for meniere’s disease?

Answer 2

Middle aged
Family history
Migraines
Autoimmune disease
Head trauma
Viral infection

Question 3

What are the clinical features of meniere’s disease?

Answer 3

Vertigo
Tinnitus (unilateral)
Fluctuating hearing loss (unilateral)
Aural fullness
Nystagmus
Positive romberg’s test
Unsteadiness
Unexplained falls without loss of consciousness

Question 4

What are the differentials of meniere’s disease?

Answer 4

Acoustic neuroma
Migraine with brainstem aura
BPPV

Question 5

What is the criteria for diagnosis of meniere’s disease?

Answer 5

Vertigo - at least two spontaneous episodes lasting between 20 minutes and 12 hours

Fluctuating - fluctuating hearing, tinnitus, and/or perception of aural fullness

Hearing loss - confirmed by audiometry to be sensorineural, low-to-mid frequency, and in the affected ear

Question 6

What investigations may be useful in suspected meniere’s disease?

Answer 6

Otoscopy
Pure-tone audiometry
MRI head - exclude acoustic neuroma
Lyme disease serology
Syphilis serology

Question 7

What is the acute management of meniere’s disease?

Answer 7

Severe attacks - prochlorperazine
Non-severe attacks - short course (7 days) of prochlorperazine or antihistamine (cyclizine or promethazine)

Question 8

What is the prophylactic treatment of meniere’s disease?

Answer 8

Betahistine