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Meniere disease

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tags—
aliasesMeniere syndrome, endolymphatic hydrops, Ménière disease

2 min read

Epidemiology

Etiology

Pathophysiology

All patients with Meniere disease have impaired endolymph resorption that results in endolymph hydrops.

  • Endolymph hydrops: accumulation of fluid in the endolymphatic sac.
  • Rupture theory: fluid accumulation in the endolymphatic sac → tear in the Reissner membrane → increased perilymphatic potassium → depolarization of the afferent acoustic nerve fibers → symptom onset
  • Compression theory: impaired endolymph resorption → compression of the semicircular canals → symptom onset

Clinical features

Meniere disease characteristically manifests as recurrent episodes of acute, unilateral symptoms that last from minutes to hours.

Meniere triad

  • Episodic vertigo: True rotational vertigo lasting 20 minutes to 24 hours (typically 2–4 hours).
  • Tinnitus
  • Asymmetric fluctuating sensorineural hearing loss (SNHL)

BPPV vs Ménière disease

  • BPPV
    • Recurrent, brief episodes (seconds)
    • Positional, Dix-Hallpike (+)
    • Only vertigo, without cochlear (e.g., hearing loss or tinnitus) or neurological symptoms.
  • Ménière disease
    • Recurrent episodes (minutes–hours)
    • Vertigo, ear fullness/pain, unilateral hearing loss & tinnitus

Diagnostics

Treatment

  • Acute Attacks (Symptomatic Relief):
    • First-line:
      • Vestibular suppressants: Meclizine, dimenhydrinate, or benzodiazepines (e.g., diazepam, lorazepam).
      • Antiemetics: Ondansetron, prochlorperazine, or promethazine.
  • Maintenance / Prophylaxis (Frequency & Severity Reduction):
    • First-line:
      • Dietary/Lifestyle modifications: Low-sodium diet (<2,000 mg/day); avoidance of caffeine, alcohol, and nicotine; stress management.
        • The inner ear microenvironment is extremely sensitive to systemic shifts in osmolality, fluid balance, and microvascular perfusion.
      • Diuretics: Oral Hydrochlorothiazide (HCTZ) or Triamterene/HCTZ (or acetazolamide) to decrease endolymph volume.
    • Second-line:
      • Intratympanic corticosteroid injections (e.g., dexamethasone).
      • Oral short-course steroids for acute hearing drops.
  • Refractory / Debilitating Disease:
    • Chemical Labyrinthectomy: Intratympanic gentamicin (ablates vestibular hair cells; carries risk of worsening SNHL).
    • Surgical Interventions:
      • Endolymphatic sac decompression or shunting (hearing-sparing).
      • Vestibular nerve section (hearing-sparing).
      • Surgical labyrinthectomy (definitive relief of vertigo; causes total, permanent ipsilateral hearing loss; reserved for patients with non-serviceable hearing).

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