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| ==Background==
| | #REDIRECT[[Ménière's disease]] |
| *Occurs due to increased endolymph within the cochlea and labyrinth
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| *First attack usually occurs in patients >65yrs
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| *Usually is unilateral but may become bilateral w/ time
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| ==Clinical Features==
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| *Episodes of sudden-onset vertigo w/ nausea/vomiting
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| **Duration: usually 2-8hr
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| **Frequency: Ranges from several episodes per week to several times per month
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| *Roaring tinnitus
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| *Diminished hearing
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| *Fullness in affected ear
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| *Between attacks pt is well (although decreased hearing may persist)
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| ==Differential Diagnosis==
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| {{Vertigo DDX}}
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| ==Diagnosis==
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| *No workup required for classical Meniere disease in the ED
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| *Confirmed by ENT via glycerol testing or vestibular-evoked potentials
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| *Imaging with MRI if suspicion or need to r/o lesions such as<ref>Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. 2000 Aug. 120(5):615-9.</ref>:
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| **[[Acoustic neuroma]]
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| **Cerebellopontine angle lesion
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| **[[Multiple sclerosis]]
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| **[[Arnold-Chiari malformation]]
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| ==Treatment==
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| *Treat vertigo symptomatically with scopolamine, antihistamines, or benzodiazepines
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| *Vestibulosuppressant options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>
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| **Meclizine 25-50 mg PO
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| **Diazepam 5-10 mg PO or IV
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| **Other options: scopolamine, promethazine, prochlorperazine, metoclopramide
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| *Diuretics may decrease fluid pressure in ear:
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| **HCTZ
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| **Acetazolamide
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| **Avoid loop diuretics due to ototoxicity
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| *Consider IM steroid injection, followed by tapered PO prednisone<ref>Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. 2002 Jun. 35(3):581-9, vii.</ref>
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| *Routine ENT referral for medical treatment failures (endolymphatic decompression, vestibular nerve section, labyrunthectomy, intra-TM injections)<ref>Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. 2010 Jan 20. CD005395.</ref><ref>Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. 2004 Oct. 37(5):955-72, v.</ref>
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| ==Disposition==
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| *Refer to ENT
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| ==References==
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| <references/>
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| [[Category:ENT]]
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| [[Category:Neurology]]
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