Meniere's disease

Abstract

Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.

The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière’s disease on MRI

“…Especially in the first years, the symptoms may be transient and incomplete. In about 9% of cases, the time period between the onset of vertigo and hearing loss can last more than 10 years [3]. In the advanced stage of Menière’s disease (MD), the symptoms are permanent.…”

“…In the advanced stage of Menière’s disease (MD), the symptoms are permanent. The clinical diagnosis of MD can be complemented with a battery of audiological, vestibular, and electrophysiological tests; however, the lack of a definitive gold standard diagnostic test still complicates the process of diagnosis [3]. …”

The relationship between endolymphatic hydrops in the vestibule and low‐frequency air‐bone gaps

“…Ménière's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness . A characteristic pathological finding in MD is endolymphatic hydrops (EH), in which excessive endolymph accumulates in the inner ear, and which typically results in sensorineural hearing loss.…”

“…M enière's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness. 1 A characteristic pathological finding in MD is endolymphatic hydrops (EH), in which excessive endolymph accumulates in the inner ear, and which typically results in sensorineural hearing loss. Occasionally, audiograms of patients with MD show unexplained conductive components, or air-bone gaps (ABGs), predominantly at low frequencies, even though no middle ear pathology can be demonstrated.…”

Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière’s Disease?

“…A method for detecting EH using magnetic resonance (MR) imaging has been developed (2). MR imaging requires high costs and is currently used in a research setting (3). Therefore, the physiological confirmation of EH is still useful for diagnosis of EH in MD (4).…”