Meniere's Disease

• Disorder of membranous labyrinth of unknown etiology
• pathology is distention and distortion of endolymph system (fluid in the semicircular canals of the ear responsible for the vestibular/balance of the body) due to poor absorbtion possibly in the endolympatic sac
• Patients are typically over 30 years of age, but occasionally observed in children or the elderly

Symptoms

• may have spells of severe whirling vetigo with retching, complete loss of balance for 3-4 hours per spell, usually with decreased hearing, increased tinnitis (ringing in ears) anda sensation of pressure in the involved ear
• between attacks, have periods of poor balance, fluctuating hearing, distroted hearing and changing tinnitis
• disease is often unpredicatble and burns out after 4-5 years, leaving significant unilateral hearing loss
• rarely becomes bilateral

Diagnosis

• typical spells
• fluctuating or low tone unilateral sensorineural hearing loss
• audiology tests show cochlear patterns
• ENG shows unilateral vestibular dysfunction

Treatment

• Prevention
  • low salt diet, quit smoking and decrease stress levels
  • diureticsstematil
  • Tranderm (patch scopolamine) - many side effects, i.e. acute glaucoma in patients with glaucoma, psychosis in children, dementia in elderly, urinary retention, acute pyloric shutdown
  • Gravol (diphenhydramine) or other anti-emetics
• Surgical
  • decompress endolymphatic sac
  • selective 8th nerve or vestibular nerve section
  • chemical labyrinthectomy using ototoxic antibiotic injected into middle or inner ear