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Ménière Disease

Ménière Disease is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Disease of the inner ear
  • Classically unilateral ear involvement (may be bilateral in up to 40% of cases)
  • Characterized by recurrent spontaneous and episodic vertigo, sensorineural hearing loss, “roaring” tinnitus, and aural fullness
  • Estimated incidence about 15/100,000 in US
  • Slight female > male (1.3:1)
  • Positive family history up to 20%
  • May develop at any age
    • Peak incidence is age 40–60 yr.
  • Affects more Whites of Northern European descent than Africans or Blacks
  • A benign disease without cure
  • Can be associated with significant morbidity

Etiology

  • Idiopathic
  • Endolymphatic hydrops: Blockage of the endolymphatic sac and duct leading to endolymphatic outflow obstruction and increased hydraulic pressure within the endolymphaticsystem:
    • Increased pressure causes a break in the membrane that separates the perilymph (potassium [K]-poor extracellular fluid) and the endolymph (K-rich intracellular fluid)
    • The resultant chemical mixture bathes the vestibular nerve receptors, leading to a depolarization blockade and transient loss of function
  • May be associated with structural abnormalities such as atrophy of the sac, hypoplasia of the vestibular aqueduct, narrowing of the endolymphatic duct, forwardly located lateral sinus causing compression, and obstruction of the endolymphatic sac
  • Autoimmune processes suggested as an etiology, with immune complex deposition in endolymphatic sac and autoantibodies directed against endolymphatic sac
  • Thought to have a genetic predisposition, leading to earlier age of onset and more severe symptoms
  • Other proposed mechanisms are subclinical viral infection causing hydrops many decades later, and ischemia of the endolymphatic sac and the inner ear
  • Need to differentiate Ménière syndrome from other disease processes that interfere with normal production or resorption of endolymph (e.g., thyroid disease, inner ear inflammation due to syphilis, medication)

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Citation

Rosen, Peter, et al., editors. "Ménière Disease." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease.
Ménière Disease. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease. Accessed April 25, 2019.
Ménière Disease. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease
Ménière Disease [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ménière Disease ID - 307649 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -