QuestionSBA
QuestionChoice
Vertigo, tinnitus and fluctuating hearing loss are classic Ménière's disease symptoms. The hallmark of the disease is that these symptoms are episodic and fluctuating in nature
32823
a
Ménière's disease
QuestionChoice
Otitis media in adults is most likely to present with otalgia. Otitis media can rarely cause vertigo or tinnitus; however it is unlikely to be intermittent or affect both ears simultaneously
32827
e
Otitis media
QuestionChoice
Vestibular neuritis and labyrinthitis are sometimes used interchangeably. However, vestibular neuritis refers to inflammation of the vestibular nerve only, whereas labyrinthitis refers to inflammation of the vestibular nerve and the labyrinth. Vestibular neuritis leads to sudden severe vertigo, which is unlikely to be affected by head movement. There is no accompanying hearing loss or tinnitus
32825
c
Vestibular neuritis
QuestionChoice
Labyrinthitis and vestibular neuritis are sometimes used interchangeably. However, labyrinthitis refers to inflammation of the vestibular nerve and the labyrinth, whereas vestibular neuritis refers to inflammation of the vestibular nerve only. Labyrinthitis can present with vertigo, hearing loss and tinnitus; however, it is more likely to present suddenly and does not follow a fluctuating course. Labyrinthitis is also more likely to be unilateral
32826
d
Labyrinthitis
QuestionChoice
BPPV is unlikely, as episodes of vertigo usually last for seconds to minutes and are related to head movement. Hearing loss and tinnitus are not typical features
32824
b
Benign paroxysmal positional vertigo (BPPV)
Concept
Chapter
# Summary

Meniere's disease is a condition characterized by the dilation of the endolymphatic spaces of the membranous labyrinth, causing episodes of vertigo lasting for 12-24 hours. Key signs and symptoms include paroxysmal vertigo, associated deafness, and tinnitus. Diagnosis typically involves clinical evaluation and audiometric testing. Management primarily involves the prophylactic use of betahistine to reduce the frequency of attacks and the acute use of prochlorperazine.  

# Definition

Meniere's disease is an inner ear disorder caused by increased fluid pressure in the endolymphatic spaces of the membranous labyrinth. This results in recurrent episodes of vertigo, hearing loss, and tinnitus.

# Epidemiology

Meniere's disease typically presents in individuals between the ages of 30 and 60 and predominantly affects only one ear. 

# Aetiology

The exact cause of Meniere's disease is unknown, but it is believed to be associated with the dilation of the endolymphatic spaces of the membranous labyrinth. This dilation leads to an increased fluid pressure within the inner ear, causing the characteristic symptoms of the disease.

# Signs and Symptoms

- Sudden attacks of paroxysmal vertigo
- Associated deafness
- Tinnitus
- Attacks often occur in clusters, with periods of remission where function is recovered
- The condition can be incredibly disabling, leaving patients bed-bound and suffering from nausea, vomiting, and fluctuating hearing.

# Differential Diagnosis

When diagnosing Meniere's disease, it's important to consider other conditions that may present with similar symptoms, such as:

- Vestibular neuritis: Characterized by sudden onset vertigo, nausea, vomiting, and unsteadiness
- Labyrinthitis: Presents with vertigo, hearing loss, and tinnitus
- Benign paroxysmal positional vertigo (BPPV): Characterized by brief episodes of mild to intense dizziness triggered by specific changes in the position of the head

# Investigations

Diagnosis of Meniere's disease typically relies on clinical evaluation and audiometric testing. Additional imaging or laboratory tests may be needed to rule out other potential causes of the symptoms.

# Management

- Prophylactic use of betahistine to reduce the frequency of attacks
- Acute use of prochlorperazine to manage symptoms during attacks
- Diuretics can also be used to reduce endolymphatic fluid, however this is only prescribed by specialists (i.e. ENT clinics)
- Surgical approaches are available, but currently lack a strong evidence base. 
- Low-salt diets can also help prevent attacks, by reducing the volume of endolymphatic fluid.

# References

[Click here for NICE CKS on Meniere's disease](https://cks.nice.org.uk/topics/menieres-disease/)

[Patient.info - Meniere's Disease](https://patient.info/ears-nose-throat-mouth/tinnitus-leaflet/menieres-disease)
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Meniere's disease
Topic
24
Ear, Nose & Throat
6565
Ménière's disease is characterized by episodic and fluctuating symptoms, including vertigo, tinnitus, and hearing loss, often accompanied by a feeling of fullness in the ear.
A 44-year-old woman visits her GP practice because of problems with intermittent, fluctuating hearing loss. She has accompanying symptoms of vertigo and tinnitus. These occurrences tend to last around an hour and have happened a few times in the last month. They were initially in her right ear, but she now experiences the same problems in both ears.

What is the most likely diagnosis?
a