Ménière Disease
Basics
- An inner ear (labyrinthine) disorder characterized by recurrent attacks of hearing loss, tinnitus, vertigo, and sensations of aural fullness
- The International Diagnostic Criteria define Ménière disease as a condition with at least two spontaneous episodes of vertigo lasting longer than 20 minutes but <12 hours, an audiogram showing evidence of low- to medium-frequency sensorineural hearing loss in one ear at any point in time, and fluctuating aural symptoms such as hearing loss, tinnitus, or aural fullness (1).
- Clinically, it involves the triad of:
- Vertigo lasting 20 minutes to 12 hours
- Audiometrically documented sensorineural hearing loss (predominantly low frequency)
- Fluctuating aural symptoms (tinnitus or aural fullness)
Description
- Often unilateral initially; nearly half become bilateral over time.
- Severity and frequency of vertigo may diminish with time, but hearing loss is often progressive and/or fluctuating.
- Usually idiopathic (Ménière disease) but may be secondary to another condition causing endolymphatic hydrops (Ménière syndrome)
- There are 5 clinical subtypes of both unilateral and bilateral disease (1).
- Type 1: refers to classic unilateral MD and metachronic bilateral MD (symptom onset in one ear followed by the other)
- Type 2: refers to delayed unilateral MD (hearing loss onset preceding vertigo onset by months or years) or synchronic bilateral MD (simultaneous symptom onset in both ears)
- Type 3: familial MD (most families have bilateral hearing loss, but unilateral patient may coexist in the same family)
- Type 4: sporadic MD with migraine
- Type 5: sporadic MD with an autoimmune disease
- System(s) affected: nervous
- Synonym(s): Ménière syndrome; endolymphatic hydrops
Epidemiology
- Predominant age of onset: 40 to 60 years
- Predominant gender: female > male (2:1)
- Race/ethnicity: white, Northern European > blacks
Incidence
Estimates 1 to 150/100,000 per year
Etiology and Pathophysiology
- Ménière syndrome may be secondary to injury or other disorders (e.g., reduced middle ear pressure, allergy, endocrine disease, lipid disorders, vascular, viral, syphilis, autoimmune). Any disorder that could cause endolymphatic hydrops could be implicated in Ménière syndrome.
- Theories include increased pressure of the endolymph fluid due to increased fluid production or decreased resorption. This may be caused by endolymphatic sac pathology, abnormal development of the vestibular aqueduct, or inflammation caused by circulating immune complexes. Increased endolymph pressure may cause rupture of membranes and changes in endolymphatic ionic gradient.
- Others include vascular compromise, cochlear trauma, and viral infection or reactivation
Genetics
Family history and genetic predisposition is found in 10% of cases with an autosomal dominant inheritance pattern (2).
Risk Factors
May include
- Stress
- Allergy
- Increased salt intake
- Caffeine, alcohol, or nicotine
- Chronic exposure to loud noise
- Certain vascular abnormalities (including migraines)
- Certain viral exposures (especially herpes simplex virus [HSV])
General Prevention
Reduce known risk factors.
Commonly Associated Conditions
- Anxiety (secondary to the disabling symptoms)
- Migraines
- Hyperprolactinemia
- Hypothyroidism
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Ménière Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688287/4.0/grapherence/d1688287.
Ménière Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688287/4.0/grapherence/d1688287. Accessed May 14, 2024.
Ménière Disease. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688287/4.0/grapherence/d1688287
Ménière Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 May 14]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688287/4.0/grapherence/d1688287.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Ménière Disease
ID - 1688287
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688287/4.0/grapherence/d1688287
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -