Ménière’s Disease: An Overview
Ménière’s disease is a chronic inner ear disorder characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness. First described by Prosper Ménière in 1861, the condition is believed to result from endolymphatic hydrops, an abnormal accumulation of fluid in the inner ear, leading to increased pressure and dysfunction of the cochlear and vestibular systems (Lopez-Escamez et al., 2016; Pullens & van Benthem, 2011). The exact etiology remains unclear, but factors such as genetic predisposition, autoimmune processes, viral infections, and vascular abnormalities have been implicated (Basura et al., 2020; Shojaku et al., 2017). Ménière’s disease typically presents in middle-aged adults and can significantly impact the patient’s quality of life due to its unpredictable and debilitating symptoms (Tyrrell et al., 2016).
Signs and Symptoms
The signs and symptoms of Ménière’s disease include recurrent vertigo attacks lasting from 20 minutes to several hours, fluctuating sensorineural hearing loss (often affecting low frequencies initially), persistent tinnitus, and a sensation of fullness or pressure in the affected ear (Lopez-Escamez et al., 2016). Diagnosis is primarily clinical and based on criteria established by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), which include episodic vertigo, audiometrically confirmed hearing loss, and tinnitus or aural fullness (Basura et al., 2020). Audiometry tests typically reveal low-frequency sensorineural hearing loss, and vestibular function tests such as videonystagmography (VNG) or electrocochleography (ECoG) may indicate abnormal inner ear function (Shojaku et al., 2017). High-resolution magnetic resonance imaging (MRI) may be used to rule out other conditions such as vestibular schwannoma (Pullens & van Benthem, 2011).
Management
Management of Ménière’s disease involves both lifestyle modifications and medical treatments aimed at reducing the frequency and severity of attacks. Dietary recommendations play a crucial role in symptom control, with patients advised to follow a low-sodium diet to minimize fluid retention in the inner ear (Basura et al., 2020). Caffeine, alcohol, and nicotine should be avoided as they can exacerbate symptoms. Diuretics such as hydrochlorothiazide are commonly prescribed to help regulate inner ear fluid balance (Pullens & van Benthem, 2011). Additional pharmacologic treatments include vestibular suppressants (e.g., meclizine) for acute vertigo attacks and corticosteroids for inflammatory control (Tyrrell et al., 2016). Intratympanic steroid or gentamicin injections may be considered for patients with severe or refractory symptoms (Shojaku et al., 2017).
Further treatment options for persistent cases include surgical interventions such as endolymphatic sac decompression, vestibular nerve section, or, in severe cases, labyrinthectomy for patients with profound hearing loss (Lopez-Escamez et al., 2016). Vestibular rehabilitation therapy (VRT) is often recommended to improve balance and reduce dizziness symptoms, particularly in patients with chronic disequilibrium (Basura et al., 2020). The long-term prognosis varies, with some patients experiencing progressive hearing loss and persistent imbalance, while others achieve symptom stability through appropriate management strategies (Tyrrell et al., 2016).
Conclusion
Ménière’s disease is a multifactorial condition with a significant impact on daily life. Accurate diagnosis and a tailored management approach, including lifestyle modifications, pharmacologic treatments, and rehabilitation therapies, can help improve patient outcomes and quality of life. Continued research is essential to better understand the underlying mechanisms and optimize therapeutic strategies.
References
Basura, G. J., Adams, M. E., Monfared, A., Schwartz, S. R., Antonelli, P. J., Burkard, R., … & Whamond, E. J. (2020). Clinical practice guideline: Ménière’s disease. Otolaryngology–Head and Neck Surgery, 162(2_suppl), S1-S55. https://doi.org/10.1177/0194599820909438
Lopez-Escamez, J. A., Carey, J., Chung, W. H., Goebel, J. A., Magnusson, M., Mandalà, M., … & Strupp, M. (2016). Diagnostic criteria for Menière’s disease. Journal of Vestibular Research, 25(1), 1-7. https://doi.org/10.3233/VES-150549
Pullens, B., & van Benthem, P. P. (2011). Intratympanic gentamicin for Ménière’s disease or syndrome. The Cochrane Database of Systematic Reviews, 3(3), CD008234. https://doi.org/10.1002/14651858.CD008234.pub2
Shojaku, H., Watanabe, Y., Yoshida, T., & Kato, M. (2017). Pathophysiology of Ménière’s disease: Recent developments and perspectives for future research. Journal of Neurology, 264(1), 4-12. https://doi.org/10.1007/s00415-016-8304-3
Tyrrell, J. S., Whinney, D. J., Ukoumunne, O. C., Fleming, L. E., Osborne, N. J., & Garside, R. (2016). Prevalence, associated factors, and comorbid conditions for Ménière’s disease. Ear and Hearing, 37(1), 79-86. https://doi.org/10.1097/AUD.0000000000000224