Meniere's disease: new concepts, new treatments

Our understanding of Meniere's disease is being revamped. For decades, the condition was thought to be caused by excessive fluid retention (hydrops) in the endolymphatic spaces of the inner ear, which led to tears or ruptures of the membranous structures that affect hearing and balance. More recently, research has shown that hydrops is not always associated with Meniere's and ought not to be considered the ultimate cause of its symptoms. New theories center on the fact that Meniere's disease may not have a single cause but may well be a common endpoint of a variety of anatomic or physiologic variables, including ischemic or even autoimmune injuries. This article describes the new thinking about Meniere's and explains why current treatment approaches, although they are based on outdated understanding, may still be valuable for alleviating symptoms in some patients.