Diagnosis and Treatment of Meniere's Disease
Management of a Condition With Vertigo, Tinnitus, and Hearing Loss
May 16, 2009
Meniere's disease is a condition that is characterized by varying degrees of vertigo (dizziness involving a spinning sensation), tinnitus (ringing in the ear), and hearing loss due to excessive endolymphatic fluid within the inner ear (endolymphatic hydrops). The symptomatic triad may also occur as a result of other conditions, but the term "Meniere's syndrome" is used instead of "Meniere's disease" in those contexts. Typically, Meniere's disease occurs in adulthood between the ages of 20 and 50 years. The precise incidence of the condition is difficult to determine and, as a result, statistical reports may vary.
Risk Factors
Although Meniere's disease is known to be associated with endolymphatic hydrops, the causes of excessive endolymphatic fluid have not been fully elucidated. Nevertheless, a number of risk factors for Meniere's have been suggested, such as a family history of Meniere's disease, autoimmune diseases, allergies, infections, metabolic conditions, and trauma to the ear.
Clinical Manifestations
As stated above, Meniere's disease involves vertigo, tinnitus, and hearing loss. Specifically, vertigo can last for up to 24 hours and is often associated with nausea and vomiting. Tinnitus can be described as a ringing, humming, or other type of foreign noise that is not related to the patient's spatial orientation. Hearing loss tends to involve sounds of low frequency first before sounds of higher frequency. The severity and frequency of these symptoms may worsen as the disease progresses untreated over time.
Diagnosis
To diagnose Meniere's disease, a physician takes a patient history to establish the symptomatic triad of Meniere's disease and to rule out other conditions causing the same symptoms. Further evaluation may entail evaluation of hearing and vestibular function. This is done using tests that include but are not limited to audiometric testing, electronystagmography, videonystagmography, electrocochleography.
Treatment
The treatment of Meniere's disease begins with conservative noninvasive modalities. The first-line therapy is restriction of dietary salt, alcohol, and caffeine, which may be combined with diuretic medications. If necessary, a variety of drugs can be used to suppress the symptoms of Meniere's disease, including but not limited to Valium and the corticosteroid prednisone.
Patients with more severe Meniere's disease may benefit from invasive treatment. One such option is the medication gentamicin, whose side effect of ototoxicity could be beneficial for Meniere's disease. This is administered by injections through the eardrum (tympanic membrane). As a last resort, patients would undergo surgery with endolymphatic sac decompression, vestibular neurectomy, or labyrinthectomy.
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