Ménière’s disease is believed to be caused by increased pressure within the endolymphatic system causing expansion of the scala media compartment. Subsequently there is either abnormal endolymphatic drainage into the utricle or toxic over-stimulation of the neuroepithelial elements of the inner ear.
AAO-HNS Guidelines for Diagnosis of Ménière’s disease:
- Two or more spontaneous episodes of vertigo, each lasting 20 min to 12 h
- Audiometrically documented low- to mid-frequency sensorineural hearing loss
- Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
- Not better accounted for by another vestibular diagnosis
Usually an MRI scan is required to rule out any sinister pathology such as a vestibular schwannoma.
Management can include:
- Conservative: avoiding stress, caffeine and alcohol
- Medical: thiazide diuretics and antiemetics (acute), betahistine (prevention)
- Further options: intratympanic injection therapy, hearing aids, invasive surgery