Meniere's DiseaseOkky♂

What is Meniere's disease ? • Disorder of the inner ear which causes

episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss.

• the area of the ear affected is the entire labyrinth, which includes both the semicircular canals and the cochlea.

• Named after French physician Prosper Ménière who first described it in 1861

Epidemiology (USA)Meniere's affects roughly 0.2% of the

population or 2 per 1000 people.Ménière's typically begins between the ages

of 30 and 60Affects men slightly more than women

What causes Meniere's Disease?• The membranous labyrinth is necessary for

hearing and balance and is filled with a fluid called endolymph.

• When your head moves, endolymph moves, causing nerve receptors in the membranous labyrinth to send signals to the brain about the body's motion.

An increase in endolymph, can cause the membranous labyrinth to dilate, as endolymphatic hydrops.

this is happen when the drainage system, that endolymphatic duct or sac is blocked.

the endolymphatic duct may be obstructed by scar tissue, or may be narrow from birth.

in some cases there may be too much fluid secreted by the stria vascularis.

Recently Research: autoimmune inner ear disease

Risk FactorsMiddle ear infectionhead traumaupper respiratory tract infectionAspirinCaffeinecigarettesalcoholexcessive consumption of salt

Symptoms• Periodic episodes of vertigo or dizziness.• Fluctuating, progressive, unilateral (in one

ear) or bilateral (in both ears) hearing loss.• Unilateral or bilateral tinnitus.• A sensation of fullness or pressure in one or

both ears.• sudden fall or drop attacks

occasional symptomsHeadachesabdominal discomfortDiarrheanystagmus, or uncontrollable rhythmical and

jerky eye movements

DiagnosisDoctors establish it with complaints and

medical historyDiagnosis is based on a combination of the

right set of symptoms.the process of diagnosis usually includes:

hearing testing (audiometry)ENG testVEMP testseveral blood tests (ANA, FTA)MRI scan of the headElectrocochleography (ECOG)

differential diagnosis• perilymph fistula• recurrent labyrinthitis• Migraine• congenital ear malformations of many kinds• syphilis• Lyme disease• tumors such as acoustic neuroma• multiple sclerosis• posterior fossa arachnoid cysts

How do I manage an attack?During an acute attack, lay down on a firm

surfaceStay as motionless as possible, with your

eyes open and fixed on a stationary objectDo not try to drink or sip water immediately,

as you'd be very likely to vomitStay like this until the severe vertigo

(spinning) passes, then get up SLOWLYAfter the attack subsides, you'll probably feel

very tired and need to sleep for several hours

Treatmentvestibular trainingmethods for dealing with tinnitusstress reductionhearing aids to deal with hearing lossand medication to alleviate nausea and

symptoms of vertigo.

MedicationAt the present time there is no cure for

Meniere's disease.The purpose of treatment between attacks is

to prevent or reduce the number of episodes, and to decrease the chances of further hearing loss and damage to the vestibular system.

Medications commonly used for an acute attack include the following:• Meclizine (Antivert), chewable (Bonine). Dose ranges from

12.5 twice/day to 50 mg three times/day.• Lorazepam (Ativan) 0.5 mg. Usual dose is twice/day or both

at the same time at onset. Tiredness is expected. • Phenergan, orally (12.5) or rectal suppository (25 mg).

Usual dose is once every 12 hours as needed for vomiting.• Compazine (orally or suppository). Usual dose is 5-10 mg

every 12 hours as needed for vomiting.• Zofran (orally or sublingual). Usual dose is 8mg q 12 hrs for

vomiting. Although Zofran isn't very strong, and doesn't always work, it also doesn't have much side effects either.

• Decadron (dexamethasone) 4 mg orally for 4-7 days. Or a "medrol dose pack”

Medications used between AttacksDiuretics

Dyazide or Maxide (triamterine/HCTZ).Moduretic (amiloride/HCTZ)Diamox (acetazolamide)

Vestibular SuppressantsClonazepam(Klonapin) 0.5 mg twice a day or as

neededlorazepam (Ativan) 0.5mg twice a day or as neededdiazepam (Valium) 2 mg twice a day or as neededmeclizine (Antivert ) 12.5 mg to 25 mg as needed

up to 3-4 times/day

Calcium Channel BlockersVerapamil 120-240 mg.NimodipineFlunarizine/Cinnarizine

SteroidsDexamethasonePrednisoneMethylprednisoline

Surgery• Surgery may be recommended if medical

management does not control vertigo.• This can be achieved through chemical

labyrinthectomy, in which a drug (such as gentamicin) that "kills" the vestibular apparatus is injected into the middle ear.

• Alternatively, surgeons can cut the nerve to the balance portion of the inner ear in a vestibular neurectomy, or the inner ear itself can be surgically removed (labyrinthectomy).

to reduce the frequency and severity of Meniere’s disease attacks

ProgressionProgression of Ménière's is unpredictable:

symptoms may worsen, disappear altogether, or remain the same.

ReferencesNIDCD (National Institute on Deafness and

other Communication Disorders)

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