Introduction
Meniere's disease is a disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age. Meniere's disease has a similar prevalence in both men and women.
Epidemiology
- Incidence: 15.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: 1:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Features
- recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
- a sensation of aural fullness or pressure is now recognised as being common
- other features include nystagmus and a positive Romberg test
- episodes last minutes to hours
- typically symptoms are unilateral but bilateral symptoms may develop after a number of years
Management
Management
- ENT assessment is required to confirm the diagnosis
- patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
- acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
- prevention: betahistine and vestibular rehabilitation exercises may be of benefit
Prognosis
Natural history
- symptoms resolve in the majority of patients after 5-10 years
- the majority of patients will be left with a degree of hearing loss
- psychological distress is common