MENIERE DISEASE (MD)

Definition
1861 Prosper Meniere  syndrome :
deafness, tinnitus, and episodic vertigo
 disorder of the inner ear. 1

idiopathic, chronic, progressive inner ear

disorder episodic attacks ,four main symptoms:
• vertigo (dizziness), tinnitus, aural fullness,
and fluctuating sensorineural hearing loss.2
 Pathogenesis
Endolymphatic hydrops.  accumulation of fluid
(endolymph) expansion of the endolymphatic space. 3
Hearing loss in MD
basilar membrane  wider and softer in the
apex than in the base of the cochlea
distension of the membranes in EH start
within the apex, as does hearing loss.4

bulging of the basilar membrane EH

disturbs sound transmission in the inner ear
 low-tone hearing loss, fluctuating hearing
loss . 5
Vertigo in MD
abnormal excitability. 6,7
leakage of high-potassium
endolymph rupture of
Reissner’s membrane/
membranous labyrinth. 8,9
Endolymph cochlea
semicircular canals
hearing improves after
vertigo attacks (Lermoyez
syndrome ).10
Risk factor
Allergies.11
Genetic –
autoimmune
Autosomal
diseases.12
Dominan.17
Hypothyroidism.13
Virures (HSV 1, 2).18
Coronary heart
disease. 14
Diabetes mellitus.15
Stress and Unusual
Events. 16
Diagnosis

no specific test for MD exists

complete history  includes a

detailed description of the pattern
of disease presentation3
Diagnosis
AAOHNS 1995 criteria for Meniere’s disease
Certain Menière’s disease
 Definitive Menière’s disease plus
histopathologic confirmation
Definite Menière’s disease
 Two or more definitive
spontaneous episodes of vertigo
lasting 20 minutes or longer
 Audiometrically documented
hearing loss on at least one
occasion
 Tinnitus or aural fullness in the
treated ear
 Other causes excluded
Probable Menière’s disease
 One definitive episode of vertigo
 Audiometrically documented
hearing loss on at least one
occasion
 Tinnitus or aural fullness in the
treated ear
 Other causes excluded
Possible Menière’s disease
 Episodic vertigo of the Menière
type without documented
 hearing loss, or sensorineural
hearing loss fluctuating or
 fixed, with disequilibrium but
without definitive episodes
 Other causes excluded
Diagnosis
2015 proposed criteria of Meniere’s disease

Definite Meniere’s disease Probable Meniere’s disease

At least two spontaneous episodes of
At least two episodes of
vertigo, each lasting from 20 minutes
to 12 hours vertigo or dizziness, each
Audiometrically documented low- lasting from 20 minutes to
frequency to medium-frequency 24 hours
sensorineural hearing loss in one ear,
defining the affected ear on at least Fluctuating aural symptoms
one occasion before, during or after (hearing, tinnitus or
one of the episodes of vertigo
Fluctuating aural symptoms
fullness) in the affected ear
(hearing, tinnitus or fullness) in the Not better accounted for by
affected ear another vestibular diagnosis
Not better accounted for by another
vestibular diagnosis
Diagnosis
clinical diagnosis MD (description
criteria of MD)
complemented :a battery of
inner ear test  examine inner
ear function (audiometry, VEMP
testing, caloric testing,
electrocochleography).3
Diagnosis
• Audiometrically documented
fluctuating low-tone
unilateral SNHL is the key to
the diagnosis of MD when
facing patients with an
PURE-TONE episodic vestibular
AUDIOMETRY syndrome.19
 Diagnosis
3/20th /2017 3/27th/2017 4/5th /2017

Serial PTA of patient with MD showing fluctuating low-tone

unilateral SNHL
Diagnosis
Diagnosis
vestibular evoked myogenic potentials
(VEMP)
Diagnosis
Glycerol Hydration Test
One of the most important diagnostic test
First introduced by Klockhoff and Lidblom in 1966
Glycerol is administered orally in doses of 1.5mg/kg
body weight in the fasting state
A rise in threshold of at least 10db in three consecutive
octave bands were considered diagnostic of Meniere’s
disease
Treatment
aim of the treatment :
• reduce the frequency, and severity, of the
vertigo crises  minimal impairment of
hearing function  hearing and tinnitus
improvement. 20
• symptomatic  related to the main
complain of the patient.
• 1st conservative
1ST STEP
modification of the lifestyle (well sleeping , decreasing
stress, low salt diet)
vestibular rehabilitation and psychotherapy
Diuretics (hydrochlorothiazide, acetazolamide and
chlorthalidone ), Betahistine
Meniett® system (Medtronic Cie, the USA), sequences
micro-pressure pulses susceptible to act on the
endolymphatic hydrops
2nd Step  intratympanic corticosteroids
3rd Step  surgical conservative treatment
(endolymphatic sac surgery (ELSS))controversial
4th Step  medical destructive treatment of
Ménière’s disease (ablation)
(Intratympanic injection of gentamicin (ITG) )
failed  more-invasive ablative procedures (vestibular
neurectomy or labyrinthectomy  destroys hearing 
only be performed profound hearing loss
Treatment
Prognosis