Hi
Hi there! How can I help you today?
What is meniers disease
Meniere's disease is a disorder of the inner ear characterized by episodes of vertigo, hearing loss, tinnitus (ringing in the ear), and a feeling of fullness in the ear. It is caused by abnormal fluid buildup (endolymphatic hydrops) in the inner ear. Episodes can last minutes to hours and tend to be unpredictable.
Searching sources...
Reading File
Searching PubMed
Meniere's disease
Finding Sources
Reading File
Reading File
Here is a thorough overview of Meniere's disease based on authoritative otolaryngology and medicine textbooks:
Meniere's Disease
What Is It?
Meniere's disease (MD) is a disorder of the inner ear caused by endolymphatic hydrops - an abnormal buildup of fluid (endolymph) in the membranous labyrinth. It produces a characteristic set of episodic symptoms affecting both hearing and balance.
Classic Symptoms (The "Tetrad")
- Fluctuating sensorineural hearing loss - typically affects low frequencies early on
- Tinnitus - ringing or roaring in the affected ear, which often worsens before an attack
- Aural fullness - a sensation of pressure or blockage in the ear
- Episodic vertigo - sudden attacks of spinning/dizziness lasting 30 minutes to 2 hours
The tinnitus, fullness, and hearing loss typically intensify as a warning before a vertigo attack strikes. - K.J. Lee's Essential Otolaryngology
Important Variants
- Cochlear hydrops: fluctuating hearing loss and tinnitus without vertigo
- Vestibular hydrops: episodic vertigo and aural fullness without hearing symptoms
- Lermoyez syndrome: tinnitus and hearing loss worsen progressively, then are suddenly relieved by a vertigo attack
- Crisis of Tumarkin (drop attacks): sudden loss of extensor power causing the patient to fall, without loss of consciousness - occurs late in the disease
Epidemiology
- In 85% of patients, only one ear is affected (unilateral)
- If the second ear becomes involved, it usually happens within 36 months
- Spontaneous remission occurs in about 60% of patients eventually
Diagnosis
- Audiometry: shows fluctuating low-tone sensorineural hearing loss with little tone decay
- ENG (electronystagmography): often normal between attacks; during attacks may show spontaneous nystagmus
- Glycerol test: oral glycerol (1.2 mL/kg) may temporarily improve hearing, tinnitus, and fullness within 1-3 hours - used as a diagnostic aid
Pathophysiology
The underlying cause is thought to involve immune dysfunction and/or abnormalities in endolymph production/reabsorption. The stria vascularis (a structure in the inner ear responsible for endolymph production) has been increasingly implicated - a 2025 systematic review (PMID: 40987969) specifically examined its role in disease pathogenesis.
A 2025 meta-analysis (PMID: 40134376) also found an association between Meniere's disease and thyroid disease, suggesting metabolic/autoimmune links.
Treatment
Medical (Conservative)
- Vestibular suppressants (e.g., meclizine) - to reduce vertigo during attacks
- Diuretics - to reduce endolymph volume
- Vasodilators - to improve inner ear circulation
- Low-sodium diet - helps reduce endolymph fluid buildup
- Intratympanic (IT) steroids (e.g., dexamethasone) - injected through the eardrum; can achieve vertigo control in 80% of patients and reduce tinnitus in ~74%, and can help many patients avoid ablative surgery
Surgical (when medical therapy fails)
Hearing-destructive procedures (when no useful hearing remains):
- Labyrinthectomy
- Translabyrinthine eighth nerve section
Hearing-preserving procedures:
- Selective vestibular nerve section (via middle cranial fossa, retrolabyrinthine, or retrosigmoid approach)
- Intratympanic gentamicin (chemical ablation of vestibular function)
- Endolymphatic sac decompression or mastoid shunt
- Cochleosacculotomy (for elderly patients with disabling vertigo and poor hearing)
Key Points to Remember
| Feature | Detail |
|---|---|
| Cause | Endolymphatic hydrops (fluid excess in inner ear) |
| Vertigo duration | 30 min - 2 hours per attack |
| Hearing loss type | Sensorineural, low-frequency, fluctuating |
| Laterality | Unilateral in 85% |
| Spontaneous remission | ~60% of cases |
| First-line treatment | Diet, diuretics, vestibular suppressants |
Sources: K.J. Lee's Essential Otolaryngology; Cummings Otolaryngology Head and Neck Surgery
This is a shared conversation. Sign in to Orris to start your own chat.