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Meniere's disease

Tsutomu Nakashima1,2, Ilmari Pyykkö3, Megan A Arroll4

  • 1Department of Rehabilitation, Ichinomiya Medical Treatment &Habilitation Center, 1679-2, Tomida-nagaresuji, Ichinomiya City, 494-0018, Japan.

Nature Reviews. Disease Primers
|May 13, 2016
PubMed

Insights

Meniere's disease (MD) involves inner ear fluid buildup causing vertigo and hearing loss. Understanding the link between endolymphatic hydrops and symptom variability is key for better diagnosis and treatment.

Area of Science:

  • Otolaryngology
  • Neurology
  • Inner Ear Disorders

Background:

  • Meniere's disease (MD) is an inner ear disorder characterized by vertigo, fluctuating hearing loss, tinnitus, and aural fullness.
  • A key pathological feature is endolymphatic hydrops (EH), an excess accumulation of endolymph leading to ganglion cell damage.
  • The onset and severity of MD symptoms in relation to EH progression remain unclear, necessitating further investigation.

Purpose of the Study:

  • To provide a comprehensive overview of Meniere's disease, covering its pathophysiology, clinical presentation, diagnostic methods, and management strategies.
  • To highlight the role of endolymphatic hydrops (EH) in MD and the current understanding of its relationship with disease symptomatology.
  • To discuss the evolving diagnostic tools, including advanced MRI techniques, and current therapeutic approaches for MD.

Main Methods:

  • Review of existing literature on Meniere's disease pathophysiology, clinical features, and diagnostic modalities.
  • Analysis of diagnostic criteria and functional tests used for MD, including audiometry, vestibular-evoked myogenic potential, caloric testing, electrocochleography, and head impulse tests.
  • Evaluation of the application of optimized MRI for direct visualization of endolymphatic hydrops (EH) in clinical practice.

Main Results:

  • Meniere's disease etiology is multifactorial, with endolymphatic hydrops (EH) being a characteristic sign.
  • Diagnosis relies on clinical symptoms, supported by functional tests and increasingly by MRI visualization of EH.
  • Management focuses on relieving acute vertigo and preventing recurrence, with conservative measures as first-line treatment, followed by intratympanic gentamicin or surgery if needed.

Conclusions:

  • Further research is needed to elucidate the variable relationship between endolymphatic hydrops (EH) and Meniere's disease symptomatology.
  • Optimized MRI offers direct visualization of EH, aiding in diagnosis and potentially guiding treatment strategies.
  • A multi-faceted approach to management, from risk factor modification to surgical intervention, is essential for controlling Meniere's disease symptoms and improving quality of life.

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