Menière syndrome

Condition

• Menière syndrome 

Definition 

• Hydrous of the labyrinth such as intralabyrinthine pressure effect. The most likely cause is an episode of viral labyrinthitis that leaves the labyrinth damaged and liable to bouts of endolymphatic hydrops. 
• Secondary forms related to otosclerosis, trauma and longstanding sensorineural hearing loss are also implicated and recognised. 

History 

• Characterised by paroxysmal attacks of 
• vertigo
• tinnitus 
• hearing loss (fluctuating or progressive) 
• Also possibly characterised by:
• nausea and vomiting 
• sweating and pallor
• Abrupt onset - patient may fall 
• Attacks last at least 20 minutes
• Variable interval between attacks (twice per month to twice per year)
• Examination 
• nystagmus (during at attack, often to side opposite the affected inner ear)
• sensorineural deafness
• caloric test impaired vestibular function 
• Audiometry 
• sensorineural deafness
• loudness recruitment
• electrocochleography 
• characteristic change

Examination 

• Sensorineural deafness
• Horizontal nystagmus 
• Caloric test demonstrates impaired vestibular function
• Electrocochleography: abnormal in Meniere syndrome 
• Normal in between attacks 

Treatment

• Acute management 
• Prochlorperazine 12.5 mg
• Long term management 
• advice to avoid caffeine
• Avoid excessive intake of ETOH and tobacco
• Advice for a low salt diet - this is the mainstay of treatment
• Alleviating anxiety by using appropriate sedation and, preferable counselling such as cognitive behaviour therapy
• Referral for a neurological assessment 
• Prescribing a diuretic to be taken daily. eTG recommends hydrochlorothiazide 25mg orally daily 
• Betahistine is recommended as a vasodilator and it may increase the blood supply to the inner ear, 8 mg to 16 mg orally, 2-3 times daily 
• Introduce to Meniere support group 
• Management if symptoms persist despite treatment
• myringotomy with grommet
• endolymphatic sac decompression 
• labyrinthectomy 

Reference:

1. John Murtagh's General Practice 5th edition

 2. Therapeutic guideline