Meniere's disease

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.

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

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

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