Meniere's Disease

Meniere's disease is a clinical syndrome that consists of four symptoms:
  • Episodes of severe, incapacitating vertigo lasting on the order of several minutes to a few hours (usually 30 minutes to 8 hours or so). The vertigo is usually a sensation of spinning, but can also be a feeling of being pushed or pulled (pulsion). In rare forms of Meniere's disease, patients experience sudden "drop-attacks", which cause them to fall suddenly to the ground without warning and without loss of consciousness (the so-called otolithic crisis of Tumarkin). These attacks last only for a few seconds, but because of their unpredictability and severity are potentially the most devastating amongst all forms of Meniere's disease.

  • Fluctuating, slowly progressive hearing loss-- the hearing loss is of a "sensorineural" type, arising in the inner ear. The hearing classically will worsen during a vertigo attack, and may improve after resolution of the acute symptoms.

  • Episodic tinnitus (abnormal perception of sound in the ear; usually a roaring, buzzing or ringing)-- there is frequently a baseline tinnitus in the ear, but this typically worsens temporarily with a vertigo attack.

  • Aural fullness-- a sensation of plugging or clogging in the ear that worsens when a vertigo attack begins.

As emphasized above, more important than the presence of these 4 symptoms in a single patient, is the pattern in which they occur. Many patients with ear problems will have one or all of these symptoms at some point. Patients with Meniere's disease will have all of them (or at least 2-3 of them) come on together in distinct episodes.

Meniere's attacks are usually very distinct. Patients with Meniere's disease will typically remember the first attack they had, and can catalogue each of the distinct episodes as they occur. This differs from many other types of vertigo and balance disorders in which the symptoms are more vague and the episodes less distinct. In between the episodes, most Meniere's patients feel well, though they can have significant disability from the uncertainty of when the next attack will come on.

What causes Meniere's disease?

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The root cause of Meniere's disease is unknown, though the symptoms are thought to be produced by an increase in the fluid pressure in the inner ear, i.e "endolymphatic hydrops." In all likelihood, a variety of insults to the ear can lead to endolymphatic hydrops as their common final pathway, thereby producing symptoms akin to those of Meniere's disease. 

When the inciting cause of hydropic symptoms is identified, then the proper descriptor is Meniere's syndrome or delayed endolymphatic hydrops. When the symptoms develop spontaneously, with no identifiable cause, it is termed Meniere's disease.