Fact-sheet: Meniere's disease
  • Idiopathic endolymphatic hydrops


Updated on 10/01/2018 at 10:02 AM

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Definition

Increased endolymphatic pressure = labyrinthine hydrops (hence the sensation of aural fullness)

Clinical features

  • Psychological background: stressed woman / anxiety / obsessions
  • Characteristic triad "VAS": paroxysmal vertigo, tinnitus, hearing loss
  • Paroxysmal peripheral vestibular syndrome:
  • Intense rotatory vertigo lasting several hours (<48H)
  • postural deviations toward the slow phase
  • Auditory signs: prodromal low-frequency tinnitus / progressive sensorineural hearing loss / aural fullness
  • !! may be NORMAL between attacks

MRI

To rule out a schwannoma

Recent innovation: possibility of visualizing endolymphatic hydrops on MRI 4 hours after gadolinium injection

Management

  • Reduction of hydrops
  • Sodium-restricted diet + thiazide diuretics
  • betahistine (improves inner ear microcirculation)
  • Corticosteroids
  • Hyperosmotic substances (transient): oral glycerol or IV mannitol
  • Surgical treatment: if medical treatment fails and vertigo is severe
  • Endolymphatic sac decompression (pressure-relieving intent; hearing preserved)
  • Vestibular nerve (CN VIII) section (hearing preserved)
  • Surgical labyrinthectomy or intratympanic gentamicin (induces anacusis) → for cases of severe hearing loss

Differential diagnosis

Recurrent vertigo (if no auditory signs)