Ménière's Disease
Complete guide to understanding and treating Ménière's disease
Ménière’s disease is a chronic inner ear disorder characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness. It affects approximately 190 per 100,000 people in the USA. The condition is associated with endolymphatic hydrops (fluid buildup in the inner ear) and presents significant heterogeneity in symptoms, progression, and treatment response.
Key Symptoms & Signs
Primary Symptoms
- •Recurring episodes of vertigo lasting 20 minutes to 12 hours
- •Fluctuating sensorineural hearing loss
- •Tinnitus (ringing in the ear)
- •Aural fullness (feeling of pressure in the ear)
- •Potential drop attacks (Tumarkin's otolithic crisis)
Associated Features
- •May develop bilaterally over time
- •Symptoms can occur together or separately
- •Variable frequency of attacks
- •Often triggered by dietary or lifestyle factors
- •Can be associated with migraine or autoimmune conditions
Clinical Subtypes
Type 1 (Classic)
Most common form (53%), sporadic without migraine or autoimmune disease.
- •No specific clinical markers
- •Classic symptom presentation
- •No family history
- •No associated conditions
- •Variable progression
Type 2 (Delayed)
Hearing loss precedes vertigo by months/years.
- •More severe hearing loss
- •Shorter disease course
- •Significant cochlear impairment
- •Often synchronous in bilateral cases
- •May have vascular risk factors
Type 3 (Familial)
Genetic component with family history.
- •Earlier age of onset
- •May include migraine (Type 3b)
- •Autosomal dominant inheritance common
- •Higher prevalence of bilateral involvement
- •Often worse initial hearing thresholds
Type 4 (Migraine-Associated)
Associated with migraine in all cases.
- •Younger age of onset
- •May overlap with vestibular migraine
- •More frequent vertigo attacks
- •Longer lasting episodes
- •May have autoimmune features
Treatment Phases
Conservative Management
- •Low-salt diet (1,500-2,000 mg/day)
- •Lifestyle modifications
- •Vestibular rehabilitation
- •Diuretics
- •Betahistine
Medical Interventions
- •Intratympanic steroid injections
- •Oral steroids in selected cases
- •Management of associated conditions
- •Regular monitoring of symptoms
- •Adjustment of medications as needed
Surgical Options
- •Endolymphatic sac decompression
- •Intratympanic gentamicin
- •Labyrinthectomy for severe cases
- •Vestibular nerve section
- •Consideration of cochlear implants
Recovery Timeline
Initial Diagnosis
Establishing diagnosis and starting conservative treatment
- •Symptom documentation
- •Dietary modifications
- •Lifestyle changes
- •Medical management initiation
Early Management (0-6 months)
Optimizing first-line treatments
- •Response assessment
- •Treatment adjustments
- •Trigger identification
- •Lifestyle adaptation
Maintenance Phase (6-24 months)
Long-term management strategies
- •Regular monitoring
- •Treatment optimization
- •Management of associated conditions
- •Quality of life improvements
Long-term Follow-up
Ongoing care and monitoring
- •Disease progression tracking
- •Hearing preservation
- •Management of bilateral progression
- •Adaptation strategies
Important Statistics
Prevention and Management
Dietary Control
Strict sodium restriction and fluid balance
Trigger Management
Identification and avoidance of personal triggers
Stress Reduction
Implementation of stress management techniques
Regular Monitoring
Ongoing symptom and progression tracking
Care Team
Otolaryngologist
Areas of Expertise:
- •Diagnosis
- •Medical management
- •Surgical interventions
Audiologist
Areas of Expertise:
- •Hearing assessment
- •Balance testing
- •Hearing aids
Vestibular Therapist
Areas of Expertise:
- •Balance rehabilitation
- •Gait training
- •Exercise programs
Primary Care Physician
Areas of Expertise:
- •Overall health management
- •Coordination of care
- •Management of associated conditions