Ménière Disease
Basics
Description
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 the U.S.
- Slight female > male (1.3:1)
- Positive family history up to 20%
- May develop at any age
- Peak incidence is age 20–40 yr
- Affects more Whites of Northern European descent than Africans or Blacks
- A benign disease without cure
- Can be associated with significant morbidity
Etiology
Etiology
- Idiopathic
- Endolymphatic hydrops: Most often-cited theory describes blockage of the endolymphatic sac and duct leading to endolymphatic outflow obstruction and increased hydraulic pressure within the endolymphatic system:
- Increased pressure causes a break in the membrane that separates the perilymph (potassium-poor extracellular fluid) and the endolymph (potassium-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, autosomal dominant inheritance pattern, 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)
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Ménière Disease." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease.
Ménière Disease. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease. Accessed November 7, 2024.
Ménière Disease. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307649/all/Ménière_Disease
Ménière Disease [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 07]. 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 - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
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 - 6
DB - Emergency Central
DP - Unbound Medicine
ER -