Meniere disease is an inner ear disorder linked to excess fluid in the inner ear (endolymphatic hydrops). It causes repeated attacks of vertigo with fluctuating hearing loss, ringing and fullness in one ear.
Key symptoms
- Spinning vertigo attacks lasting 20 minutes to 12 hours
- Fluctuating low-pitch hearing loss in one ear
- Ringing (tinnitus) and ear fullness
- Nausea and vomiting during attacks
What you find on exam
- Normal exam between attacks, or hearing loss on one side
- Weber and Rinne tests point to sensorineural loss
- Nystagmus during an attack
- Normal neurological exam
Tests
- Audiogram: low-frequency sensorineural hearing loss
- MRI with contrast to rule out acoustic neuroma
- Vestibular testing by ENT
Treatment basics
- Low-salt diet and less caffeine and alcohol
- Diuretic such as hydrochlorothiazide in some patients
- Meclizine or a benzodiazepine only for short attacks
- Steroid or gentamicin injection into the middle ear for refractory cases
- Vestibular rehabilitation and hearing aids
Red flags
- Sudden hearing loss (needs urgent steroid treatment)
- Neurological symptoms: double vision, weakness, slurred speech
- Sudden drop attacks with falls
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.