-IBIS-1.5.0-
tx
nervous system
Meniere's disease
diagnoses

definition and etiology

definition:
A condition characterized recurrent severe vertigo, sensorineural hearing loss, tinnitus, and associated with overall dilation of the labyrinthine membrane (endolymphatic hydrops).

etiology:
The disease is idiopathic and the pathophysiology unclear. The patient suffers from extremely sudden bouts of incapacitating vertigo that can last from a few hours to a couple of days and are accompanied by nausea and vomiting. The deafness and tinnitus appear and worsen as the disease progresses. Away from acute attacks, the patient may complain of a fullness in the affected ear(s). Although only one ear is usually involved, in 10-15% of patients, there may also be bilateral presentation. Frequently Meniere's disease has its onset in the 5th decade of life, but it is not uncommon for the young and old to also suffer from the syndrome. It is thought that the dilation of the endolymphatic system causes degeneration of the fine vestibular and cochlear hair cells. In Lermoyez's variant of the disease, hearing loss and tinnitus precede the onset of vertigo by several months or even years: once the vertigo begins the hearing may improve.

signs and symptoms

signs and symptoms:
• Acute attacks of incapacitating vertigo necessitating bedrest.
• Nausea and vomiting with attacks.
• Tinnitus and hearing loss that worsen over the years.

lab findings: Not informative, but may be used to rule/out viral or bacterial infection of the ear(s); brain tumor etc.

course and prognosis

Conventional treatments include sedatives, antinauseants, surgery including destruction of the labyrinth, but most are purely symptomatic. Vertigo tends to diminish as hearing loss proceeds.

Alternative treatments for endolymphatic hydrops have met with some success.

differential diagnosis

• labyrinthitis
• otitis media
• acoustic neuroma
• vestibular neuronitis
• ischemic disease


footnotes