Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, and tinnitus. It affects around 190 per 100,000 people in the US, most commonly between ages 40-60. The pathophysiology is not fully understood. Diagnosis involves ruling out other conditions and observing characteristic symptoms over time. Treatment aims to relieve acute symptoms, prevent recurrences, and stop progression, using medications, injections, or rarely surgery.

1. Meniere’s Disease
Ade Wijaya, MD
November 2017

2. Outline
Introduction
Epidemiology
Pathophysiology
Clinical features
Classification
Diagnosis
Differential diagnosis
Management
Summary

3. Introduction
First described by Prosper Meniere, 19 th century
Disorder of inner ear
Recurrent self-limiting vertigo
Unilateral hearing loss and tinnitus during attack
Bronstein A, Lempert T. Dizziness. A practical approach to diagnosis and management. Cambridge University Press, 2007.
Fiorino F, Pizzini FB. MRI performed after intratympanic gadolinium administration in patients with Meniere’s disease. Correlation with symptoms and signs. Eur Arch Otolaryngol 2011;268:181-7.

4. Epidemiology
190 per 100.000 in the US
4th – 6th decade of life
24 % bilateral MD
Woman > man
Sporadic; 5-15
Related to allergy, autoimmune, migraine
Nakashima, T., Pyykkö, I., Arroll, M. A., Casselbrant, M. L., Foster, C. A., Manzoor, N. F., ... & Young, Y. H. (2016). Meniere's disease.Nature Reviews Disease Primers, 2, nrdp201628.
Harris JP, Alexander TH. Current-day prevalence of Meniere’s syndrome. Audiol Neurootol 2010;15:318-22.
McCormick A, Fleming D, Charlton J. Morbidity statistics from general practice—fourth national study. 1991-1992. Office of Population Censuses and Surveys, 1995.

5. Pathophysiology
Nakashima, T., Pyykkö, I., Arroll, M. A., Casselbrant, M. L., Foster, C. A., Manzoor, N. F., ... & Young, Y. H. (2016).
Meniere's disease.Nature Reviews Disease Primers, 2, nrdp201628.

6. Clinical Features

7. Classification

8. Diagnostic
Barraclough K, Bronstein A. Diagnosis in general practice: vertigo. BMJ 2009;339:749-52

9. Diagnostic
Harcourt, J., Barraclough, K., & Bronstein, A. M. (2014). Meniere’s disease. Bmj, 349, g6544.

10. Differential Diagnosis

11. Management
Goals:
1. Relief acute symptoms
2. Prevent reccurence
3. Eliminate progression

12. Management
Acute vertigo treatment: phenothiazine / antihistamine and benzodiazepine
Prevent reccurence: betahistin, diuretic, corticosteroid, aminoglycoside
surgery

13. Summary
Meniere’s disease is a rare cause of new onset vertigo compared with more
common conditions such as benign paroxysmal positional vertigo or vestibular
migraine
Pure tone audiometry is the most useful diagnostic test for Meniere’s disease
Although Meniere’s disease has no definitive cure, medical management and in
some cases intratympanic ablation using gentamicin considerably reduces symptoms
and disability from the condition
Open surgery should be a rare option for the condition
Rehabilitation of audiovestibular loss is important and many patients may require
psychological support