A long term inner ear disorder

Epidemiology

• A population-based UK study found an overall incidence rate of 13.1 per 100,000 person-years, with the diagnosis more common in women.
• The diagnosis of Ménière's disease is most commonly made in people aged 40-50 years

Aetiology

Exact cause is unknown but is probably multifactorial. Possible risk factors:

• Allergy - eg, food allergy.
• Autoimmunity, including antiphospholipid antibodies, RA, lupus
• Genetic susceptibility.
• Metabolic disturbances involving the balance of sodium and potassium in the fluid of the inner ear.
• Vascular factors (there is an association between migranine and Ménière's disease).
• Viral infection, otosyphilis, Cogan's syndrome (non-syphilitic interstitial keratitis and bilateral audiovestibular deficits).

Pathophysiology

Ménière’s disease is associated with the excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals. This increased pressure of the endolymph is called endolymphatic hydrops.

PC

Typical triad of symptoms - unilateral episodes of vertigo, hearing loss, and tinnitus.

Vertigo:  in Ménière’s disease comes in episodes. These last for 20 minutes to several hours before settling. These episodes can come in clusters over several weeks, followed by prolonged periods (often months) without vertigo symptoms. Vertigo is not triggered by movement or posture.