DIZZINESS-MENIERE DISEASE

SUMMARY

1. Characterized by recurrent, spontaneous attacks of vertigo assoc. with unilateral hearing loss, ear fullness, intermittent tinnitus with peak incidence between 40-60 yrs of age.

2. Triad of episodic vertigo (assoc. with nausea & vomiting) and tinnitus, with low-frequency hearing loss after recurrent episodes lasting 20min-12hrs.

3. Pathology: increase in the volume of endolymph and distention of the endolymphatic system (endolymphatic hydrops), partly related to salt intake.

4. Etiology: neurosyphilis (check serum VDRL or RPR), post-trauma, post-viral infection, autoimmune causes.

5. Anti-histamines (Betahistine: potent H3 receptor antagonist & weak H1 agonist), anti-emetics, and sedatives are used in acute episodes.

6. Chronic treatment includes eradicating caffeine and reducing the intake of salt, alcohol, nicotine, and MSG. Thiazide diuretics are used when spells continue after dietary modification. 95% of patients get their disease under control and function normally.

7. For recalcitrant disease: intratympanic corticosteroid/gentamicin administration, endolymphatic-mastoid shunt, vestibular neurectomy, labyrinthectomy.

8. Recurrent attacks may lead to permanent deafness.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].