Diagnosis of Menière's disease is made with a characteristic patient history, including discrete episodes of
vertigo lasting 20 min or longer, accompanied by
sensorineural hearing loss, which is typically low frequency at first, aural fullness, and
tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune
inner ear disease, perilymphatic
fistula, superior semicircular canal syndrome,
Lyme disease,
multiple sclerosis, vestibular paroxysmia, and temporal bone
tumors. A history of
migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011-1017, 2010). Treatment begins with conservative measures, including
low salt diet, avoidance of stress and
caffeine, and sleep hygiene. Medical
therapy with a
diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT)
steroids and
betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of
vertigo, then ablative
therapies like intratympanic
gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with
gentamicin.
Benzodiazepines and
anti-emetics are used for symptomatic control during
vertigo episodes. Rehabilitative options for unilateral vestibular weakness include
physical therapy and for
unilateral hearing loss include conventional
hearing aids, contralateral routing of sound (CROS) and osseointegrated
hearing aids.