CE/CME

Ménière’s Disease: A Lifelong Merry-Go-Round

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HISTORY AND EXAMINATION
Obtaining a detailed history from the patient and completing thorough neurologic and otologic examinations are essential components of the diagnostic process. Audiometry should be completed to evaluate neurosensory hearing loss, as audiometrically documented hearing loss is part of the AAO-HSN diagnostic criteria for Ménière’s disease.6

Based on findings from the patient’s history, physical exam, and audiometric testing, a tentative diagnosis can be made. The role and inclusion of adjunctive tests in the diagnostic process varies considerably by region in the US. While not required for the diagnosis of Ménière’s disease, electrical vestibular stimulation and videonystagmography are useful tests to assess abnormalities in vestibular function and monitor disease progression, which may help determine intervention options.6 Additional diagnostic tests may be suggested due to the essential need to exclude other potential causes of vertigo prior to determining the final diagnosis of Ménière’s disease.

Triggers of Vertigo
Selected triggers of vertigo that must be considered are benign paroxysmal positional vertigo (BPPV), labyrinthitis, acoustic neuroma, migraine with vertigo, and cerebral vascular events.6 Diagnostic tests are indicated to rule out certain problems, such as MRI to exclude a tumor or an acoustic neuroma. Distinct differences noted during a complete assessment may help eliminate certain disorders. BPPV is triggered by a change in physical position and usually lasts less than one minute; the diagnosis can be confirmed by the Dix-Hallpike maneuver.4 Labyrinthitis is characterized by acute vertigo associated with continuing imbalance, while instability with walking resolves completely between vertigo episodes in Ménière’s disease.4 If abnormal neurologic manifestations are noted during the exam or reported in a patient’s account of a vertigo episode, then a transient ischemic attack or stroke must be ruled out by more detailed diagnostic testing.

TREATMENT OPTIONS
Presently, no evidence-based guidelines exist for the treatment of Ménière’s disease, and the evidence supporting the efficacy of currently used therapies is inconsistent. However, several medicines and treatments are useful in relieving symptoms and improving a patient’s quality of life.

Primary care clinicians can initiate treatment for Ménière’s disease through lifestyle recommendations and prescription of specific medications. Everyday adjustments that incorporate dietary changes, stress reduction, adequate sleep, and regular exercise have been shown to improve vertigo symptoms in 60% of patients with Ménière’s disease.5,9

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