Clinical Practice Guideline: Ménière's Disease Executive Summary. Otolaryngol Head Neck Surg. 2020 Apr;162(4):415-434. doi: 10.1177/0194599820909439. Otolaryngol Head Neck Surg. 2020. PMID: 32267820 Show
Original Editors -Elaine Lonnemann Top Contributors - Mercedes Nelson, Mary Glorighian, Deborah Bruckman, Lucinda hampton, Kim Jackson, Tony Lowe, Elaine Lonnemann, Vidya Acharya, Admin, Wendy Walker, Hayley Lawler, WikiSysop, Uchechukwu Chukwuemeka, Mande Jooste, Laura Ritchie, Scott Buxton, Naomi O'Reilly and Magdalena Hytros Meniere disease (or idiopathic endolymphatic hydrops) is a disorder of the inner ear characterized by hearing loss, tinnitus, and vertigo. It is named after the French physician Prosper Ménière (1799-1862) who first recognised vertigo as an inner ear disorder.
The 2 minute 45 second video below fives a good summary [3] Epidemiology[edit | edit source]The prevalence of Meniere disease varies between 3.5 per 100.000 and 513 per 100.000 and occurs more often in older, white and female patients. The identification of several comorbidities which occur in an increased fashion in patients with Meniere disease gave rise to new theories about the origins of the disease. Etiology[edit | edit source]
The exact etiology of Meniere disease remains unclear. Different theories exist, but genetic and environmental factors play a role. The relation to common comorbidities remains elusive[4].
[5] Related conditions[6]
Risk Factors[6]
Characteristics/Clinical Presentation[edit | edit source]One or both ears can be affected. The chief symptoms are:
Evaluation[edit | edit source]The American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium set criteria for diagnosing Ménière disease, most recently revised in 1995:
The role of imaging is controversial, but improved spatial resolution in CT and MRI is likely to show where the endolymphatic flow is impaired[1].
Audiometric evaluation is mandatory in all patients with Meniere disease.
Vestibular (caloric) function testing may show a significantly under-functioning affected organ in 42% to 74% and a full loss of function in 6% to 11%
Differential Diagnosis[edit | edit source]Other conditions can produce the same symptoms as Ménière’s disease and must be ruled out in order to develop an accurate diagnosis. The differential diagnosis is broad and includes:[10]
Management[edit | edit source]Different treatment options for Meniere disease exist with substantial variability between countries. None of the treatment options cure the disease. As many treatments have a significant impact on the functioning of surrounding structures, start with non-invasive approaches with the fewest possible side effects and proceed to more invasive steps.
Lifestyle Modifications
Hearing Aid
Physical Therapy Management[edit | edit source]Despite the fact that physical therapy cannot address the underlying cause of Ménière’s disease physiotherapy management can assist patients in several ways:[11]
Home Modification is often an overlooked physical therapy management tool for Meniere’s disease and other vestibular diseases. However, it is very important to the patient’s safety, especially since people with Meniere’s disease have a hard time predicting when an episode of vertigo will occur. All physical therapist who work with Meniere’s patients should be able to explain Home Safety. To help safeguard against dangerous falls, suggest the following household improvements are suggested:[13]
Case Reports/ Case Studies[edit | edit source]Real Clinical Case Example of a Patient with Meniere's Disease: An 82 year-old female patient presents with severe dizziness and ringing in the ears. She reports having frequent attacks of dizziness with an insidious onset. The patient stated that the first attack of dizziness she experienced was in November of 1968 when she was 34 years old. It was election day and as she got off the couch to go vote, she became very dizzy. After the first attack, she had recurring attacks once every four to five years until the mid-2000's when they started to become more frequent. Her doctor gave her a medication that made her sleep, but she didn't have any other medical treatments. In 2012, the attacks became more severe causing her to seek further medical attention. Her primary care provider prescribed her Meclizine to help control the dizziness and nausea. The medication helped to control the attacks for awhile, but soon they became more severe and lasted from 48-72 hours as she developed a tolerance to Meclizine. In 2015, she went to an Ear, Nose & Throat (ENT) doctor that specialized in hearing disorders. A CT scan and MRI were performed to rule out other pathologies and both came back negative. After a series of hearing, vision and vestibular testing, the ENT diagnosed the patient with Meniere's disease. The doctor gave her a steroid injection into the eardrum which significantly helped to manage the dizziness and tinnitus. The patient now receives yearly steroid injections and was fitted with a hearing aid to help with the hearing loss due to the disease. The patient also takes Meclizine every day as a preventative measure. The patient has been diagnosed for two years now and has learned to self-manage the attacks. She is also better at detecting when an attack is about to happen based on the tinnitus. When the ringing in her ears turns into a rushing water sound or sounds like someone walking through mud, she knows she needs to stop what she is doing and take a break until the symptoms go away. Laying down in a dark room and listening to classical music on headphones helps to prevent a severe attack. The disease has also impacted her activities of daily living as she can no longer drive and she is very sensitive to busy backgrounds with a lot of visual input. All of this impacts her ability to go to the store and be a passenger in a car. [14] Resources[edit | edit source]References[edit | edit source]
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