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Menieres Disease

Is an abnormal inner ear fluid balance

caused by a malabsorption in the

endolymphatic sac or a blockage in the
endolymphatic duct.
Endolymphatic hydrops, a dilation in the

endolymphatic space, develops, and either

increased pressure in the system or rupture
of the inner ear membrane occurs,
producing symptoms of Menieres disease.

Menieres disease affects 15 to 50 people

per 100,000 people in the United States.

More common in adults, it has an average
age of onset in the 40s, with symptoms
usually beginning between the ages of 20
and 60 years. Menieres disease appears to
be equally common in men and women,
and it occurs bilaterally in about 20% of
patients. About 50% of the patients who
have Menieres disease have a positive
family history of the disease.

Symptoms of Menieres disease include:
progressive sensorineural hearing loss;
tinnitus or a roaring sound;
a feeling of pressure or fullness in the ear;
and episodic, incapacitating vertigo, often
accompanied by nausea and vomiting.

Some clinicians believe that there are two subsets of

the disease:

Cochlear Menieres disease is recognized as

a fluctuating, progressive sensorineural

hearing loss associated with tinnitus and
aural pressure in the absence of vestibular
symptoms or findings.
Vestibular Menieres disease is

characterized as the occurrence of episodic

vertigo associated with aural pressure but
no cochlear symptoms.

Physical examination findings are usually

normal, with the exception of those cranial

nerve VIII. Sounds from a tuning fork
(Weber test) may lateralize to the ear
opposite the hearing loss, the one affected
with Menieres disease.
An audiogram typically reveals a
sensorineural hearing loss in the affected
ear. This can be in the form of a Pikes
Peak pattern, which looks like a hill or
The electronystagmogram may be normal

Most patients with Menieres disease can be

successfully treated with diet and medication. Many

patients can control their symptoms by adhering to
a low-sodium (1000 to 1500 mg/day or less) diet.
The amount of sodium is one of many factors that
regulate the balance of fluid within the body. Sodium
and fluid retention disrupts the delicate balance
between endolymph and perilymph in the inner ear.
Psychological evaluation may be indicated if a

patient in anxious, uncertain, fearful, or depressed.

Pharmacologic therapy for Menieres disease
consists of:
Antihistamines such as Meclizine (Antivert),
Tranquilizers such as Diazepam (Valium)
Antiemetic agents such as Promethazine
Diuretic therapy (eg, hydrochlorothiazide
[Dyazide], triamterene [Dyrenium])
Intake of foods containing potassium (eg,
bananas, tomatoes, oranges) is necessary
if the patient takes diuretic that causes
potassium loss.

In patients who may be noncompliant with

the therapeutic regimen, intratympanic

injection of gentamicin (Garamycin) is
being used to cause ablation of the
vestibular hair cells. However, the rsik of
significant hearing loss is high.

Although most patients respond well to

conservative therapy, some continue to

have disabling attacks of vertigo. If these
attacks reduce their quality of life, patients
may elect to undergo surgery for relief.
Surgical procedures include endolymphatic
sac procedures and vestibular nerve
However, hearing loss, tinnitus, and aural

fullness may continue, because the surgical

treatment of Menieres disease is aimed at
eliminating the attacks of vertigo.

Assess for vertigo, including history, onset,

description of attacks, duration, frequency,

and any associated ear symptoms (hearing
loss, tinnitus, aural fullness)
Encourage patient to sit down when dizzy.
Place pillow on each side of head to restrict
Recommend that the patient keep eyes
open and stare straight ahead when lying
down and experiencing vertigo.
Limit foods high in salt or sugar. Be aware
of foods with hidden salts and sugars.