Meniere's disease

Background

• Occurs due to increased endolymph within the cochlea and labyrinth
• First attack usually occurs in pts >65yrs
• Usually is unilateral but may become bilateral w/ time

Clinical Features

• Episodes of sudden-onset vertigo w/ nausea/vomiting
  • Duration: usually 2-8hr
  • Frequency: Ranges from several episodes per week to several times per month
• Roaring tinnitus
• Diminished hearing
• Fullness in affected ear
• Between attacks pt is well (although decreased hearing may persist)

Differential Diagnosis

Vertigo

• Vestibular/otologic
  • Benign paroxysmal positional vertigo (BPPV)
  • Traumatic (following head injury)
  • Infection
    • Labyrinthitis
    • Vestibular neuritis
    • Ramsay Hunt syndrome
  • Ménière's disease
  • Ear foreign body
  • Otic barotrauma
  • Otosclerosis
• Neurologic
  • Cerebellar stroke
  • Vertebrobasilar insufficiency
  • Lateral Wallenberg syndrome
  • Anterior inferior cerebellar artery syndrome
  • Neoplastic: cerebellopontine angle tumors
  • Basal ganglion diseases
  • Vertebral Artery Dissection
  • Multiple sclerosis
  • Infections: neurosyphilis, tuberculosis
  • Epilepsy
  • Migraine (basilar)
• Other
  • Hematologic: anemia, polycythemia, hyperviscosity syndrome
  • Toxic
    • Alcohol
    • Aminoglycosides
  • Chronic renal failure
  • Metabolic
    • Thyroid Disease
    • Hypoglycemia

Diagnosis

• Confirmed by ENT via glycerol testing or vestibular-evoked potentials

Treatment

• Treat vertigo symptomatically with scopolamine, antihistamines, or benzodiazepines

Disposition

• Refer to ENT