Hearing Health Guide
Definition
Meniere's disease is a chronic condition of the inner ear characterized by episodes of intense, spontaneous vertigo lasting 20 minutes to 12 hours, accompanied by fluctuating sensorineural hearing loss, tinnitus, and aural fullness, typically in one ear. It is associated with endolymphatic hydrops, an abnormal accumulation of endolymph (inner ear fluid) that is thought to disrupt the fluid balance required for normal cochlear and vestibular function.
A Meniere's attack typically begins with aural fullness and increased tinnitus, followed by a sudden onset of intense rotational vertigo that lasts from 20 minutes to several hours, accompanied by nausea and sometimes vomiting. Hearing fluctuates, often worsening during attacks and partially recovering afterward, at least in early disease.
Over time, hearing loss tends to become permanent and progressive, predominantly affecting low-to-mid frequencies. This is an unusual pattern that distinguishes Meniere's from presbycusis and noise-induced loss, which affect high frequencies first. The vestibular symptoms often stabilize or 'burn out' as the disease progresses, while hearing deteriorates.
Diagnosis is clinical. There is no definitive blood test or imaging study that confirms Meniere's disease. The AAO-HNS diagnostic criteria require: two or more definitive spontaneous episodes of vertigo lasting 20 minutes to 12 hours, audiometrically documented low-to-mid frequency sensorineural hearing loss in the affected ear, fluctuating aural symptoms (tinnitus or fullness), and exclusion of other causes.
MRI is typically ordered to rule out acoustic neuroma and other retrocochlear pathology. Electrocochleography (ECoG), a test of cochlear fluid pressure, may support the diagnosis.
First-line management includes a low-sodium diet (targeting below 1,500-2,000 mg/day), diuretics (typically hydrochlorothiazide-triamterene), and avoiding caffeine and alcohol. All of these aim to reduce endolymph volume.
For patients with refractory vertigo, intratympanic gentamicin injections (which selectively ablate the vestibular hair cells) are effective at controlling vertigo with a risk of further hearing loss. Endolymphatic sac surgery and vestibular nerve section are options for severe cases. Hearing rehabilitation (hearing aids) addresses the cochlear component.
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