Meniere's disease

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.