Menière’s Disease

The leading symptoms of Menière’s disease are recurrent attacks of vertigo associated with impairment of hearing, tinnitus and fullness in the affected ear. It is evidently caused by an imbalance between the production and reabsorption of the endolymph, leading to an endolymphatic hydrops. The increased pressure from the excess fluid leads to the rupture of the membrane separating the endolymph space from the perilymph space and/or the opening of cation channels. The result is an increase of potassium-levels in the perilymph space causing a transient excitation followed by depolarization.

Signs and Symptoms

The current diagnostic criteria for Menière disease are as follows: Recurrent attacks of vertigo, lasting 20 min to 12 hours, hearing impairment (< 2000 Hz, at least 30 dB, related to the attacks of vertigo) and fluctuating tinnitus and fullness in the affected ear. During an attack first a nystagmus toward the affected ear due to excitation and then toward the non-affected ear due to the conduction block can be observed.

Diagnosis

Audiological testing is necessary to make the diagnosis because a hearing impairment < 2000 Hz of at least 30 dB in the affected ear is required. In addition vestibular diagnostic measures may be helpful, which typically show a reduced caloric response and a normal head-impulse test. The endolymphatic hydrops can be visualized by high-resolution MRI after injection of gadolinium.

Observable ocular motor disorders

  • Nystagmus during the acute attack: first towards the affected ear (indicating a excitation) and then to the non-affected ear (indicating a hypofunction)

References

Lopez-Escamez JA et al. (2015) Diagnostic criteria for Meniere’s disease. J Vestib Res 25:1-7. PubMed