Ménière Disease

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Basics

Description

  • An inner ear (labyrinthine) disorder characterized by recurrent attacks of hearing loss, tinnitus, vertigo, and sensations of aural fullness due to an increase in the volume and pressure of the inner ear endolymph fluid (endolymphatic hydrops)
  • 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)
  • System(s) affected: nervous
  • Synonym(s): Ménière syndrome; endolymphatic hydrops

Epidemiology

  • Predominant age of onset: 40 to 60 years
  • Predominant gender: female > male (1.3:1)
  • Race/ethnicity: white, Northern European > blacks

Incidence
Estimates 1 to 150/100,000 per year

Prevalence
Varies from 7.5 to >200/100,000

Etiology and Pathophysiology

  • Not fully understood; 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.
  • 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.

Genetics
Some families show increased incidence, but genetic and environmental influences are incompletely understood.

Risk Factors

May include

  • Stress
  • Allergy
  • Increased salt intake
  • Caffeine, alcohol, or nicotine
  • Chronic exposure to loud noise
  • Family history of Ménière
  • Certain vascular abnormalities (including migraines)
  • Certain viral exposures (especially herpes simplex virus [HSV])

General Prevention

Reduce known risk factors: stress; salt, alcohol, and caffeine intake; smoking; noise exposure; ototoxic drugs (e.g., aspirin, quinine, aminoglycosides).

Commonly Associated Conditions

  • Anxiety (secondary to the disabling symptoms)
  • Migraines
  • Hyperprolactinemia
  • Hypothyroidism

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Basics

Description

  • An inner ear (labyrinthine) disorder characterized by recurrent attacks of hearing loss, tinnitus, vertigo, and sensations of aural fullness due to an increase in the volume and pressure of the inner ear endolymph fluid (endolymphatic hydrops)
  • 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)
  • System(s) affected: nervous
  • Synonym(s): Ménière syndrome; endolymphatic hydrops

Epidemiology

  • Predominant age of onset: 40 to 60 years
  • Predominant gender: female > male (1.3:1)
  • Race/ethnicity: white, Northern European > blacks

Incidence
Estimates 1 to 150/100,000 per year

Prevalence
Varies from 7.5 to >200/100,000

Etiology and Pathophysiology

  • Not fully understood; 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.
  • 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.

Genetics
Some families show increased incidence, but genetic and environmental influences are incompletely understood.

Risk Factors

May include

  • Stress
  • Allergy
  • Increased salt intake
  • Caffeine, alcohol, or nicotine
  • Chronic exposure to loud noise
  • Family history of Ménière
  • Certain vascular abnormalities (including migraines)
  • Certain viral exposures (especially herpes simplex virus [HSV])

General Prevention

Reduce known risk factors: stress; salt, alcohol, and caffeine intake; smoking; noise exposure; ototoxic drugs (e.g., aspirin, quinine, aminoglycosides).

Commonly Associated Conditions

  • Anxiety (secondary to the disabling symptoms)
  • Migraines
  • Hyperprolactinemia
  • Hypothyroidism

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