Clinical Practice Guideline: Ménière’s Disease Executive Summary

Abstract

Objective Ménière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. Purpose The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

Meniere’s Disease

“…Becker-Bense et al hypothesized that the main cause of this female predominance was because there was a mixture of patients who had vestibular migraine which the symptoms is similar with Meniere's disease. In some Meniere's disease patients, the symptoms of decreased hearing function are the most significant symptoms in the first decade of diagnosis, however the patient continues to experience a deterioration that makes this a chronic disease (4,5).…”

“…The diagnostic criteria for Meniere's disease has been revised by the Classification Committee of the Barany Society and resulted in 2 categories: Definitive Meniere's disease; two or more spontaneous vertigo attacks, each lasting 20 minutes to 12 hours, audiometric examination reveals low-to-moderate frequency fluctuation of sensorineural hearing loss in the affected ear at least 1 time before, during, or after one vertigo episode, fluctuating aural symptoms (hearing loss, tinnitus, or aural pressure) in the affected ear, other causes excluded by other tests. Possible Meniere's Disease; at least 2 episodes of vertigo or dizziness lasting 20 minutes to 24 hours, fluctuating aural symptoms (hearing loss, tinnitus, or aural pressure) in the affected ear, other causes excluded by other tests (4,6,(9)(10)(11). The diagnosis of Meniere's disease was made clinically.…”

“…Thus, the diagnosis of Meniere's disease is usually not made at 1 point in time, it may take months or even years to fully lead to a definitive diagnosis. To maximize treatment, it is important to differentiate Meniere's disease from other independent causes of vertigo and present with hearing loss, tinnitus, for example, BPPV, acute labyrinthitis, migraine which are responding to different treatments (4,12). Furthermore, there is a tool to make a diagnosis, the Gibson 10 point score, where a score of 7 or more leads to a diagnosis of Meniere's disease (2).…”

“…The AAO-HNS suggests caffeine restriction because caffeine can induce endolymph volume modification. Some assume that a low amount of caffeine, such as 100 mg/ day, will not trigger Meniere's symptoms (4,13). Patients are also advised to avoid alcohol and tobacco.…”

“…Contraindications to the use of thiazides are patients with gout and potassium-sparing diuretics are contraindicated in patients with acute or severe renal failure. Patients using diuretics should be monitored for electrolytes and blood pressure (4).…”