fbpx
Wikipedia

Ménière's disease

Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear.[3][4] Typically, only one ear is affected initially, but over time, both ears may become involved.[3] Episodes generally last from 20 minutes to a few hours.[5] The time between episodes varies.[3] The hearing loss and ringing in the ears can become constant over time.[4]

Ménière's disease
Other namesMénière's syndrome, idiopathic endolymphatic hydrops[1]
Diagram of the inner ear
Pronunciation
SpecialtyOtolaryngology, Neurology
SymptomsFeeling like the world is spinning, ringing in the ears, hearing loss, fullness in the ear[3][4]
Usual onset40s–60s[3]
Duration20 minutes to few hours per episode[5]
CausesUnknown[3]
Risk factorsFamily history[4]
Diagnostic methodBased on symptoms, hearing test[3]
Differential diagnosisVestibular migraine, transient ischemic attack[1]
TreatmentLow-salt diet, diuretics, corticosteroids, counselling[3][4]
PrognosisAfter ~10 years hearing loss and chronic ringing[5]
Frequency0.3–1.9 per 1,000[1]

The cause of Ménière's disease is unclear, but likely involves both genetic and environmental factors.[1][3] A number of theories exist for why it occurs, including constrictions in blood vessels, viral infections, and autoimmune reactions.[3] About 10% of cases run in families.[4] Symptoms are believed to occur as the result of increased fluid buildup in the labyrinth of the inner ear.[3] Diagnosis is based on the symptoms and a hearing test.[3] Other conditions that may produce similar symptoms include vestibular migraine and transient ischemic attack.[1]

No cure is known.[3] Attacks are often treated with medications to help with the nausea and anxiety.[4] Measures to prevent attacks are overall poorly supported by the evidence.[4] A low-salt diet, diuretics, and corticosteroids may be tried.[4] Physical therapy may help with balance and counselling may help with anxiety.[3][4] Injections into the ear or surgery may also be tried if other measures are not effective, but are associated with risks.[3][5] The use of tympanostomy tubes (ventilation tubes) to improve vertigo and hearing in people with Ménière's disease is not supported by definitive evidence.[5]

Ménière's disease was identified in the early 1800s by Prosper Menière.[5] It affects between 0.3 and 1.9 per 1,000 people.[1] It typically starts in people 40 to 60 years old.[3][6] Females are more commonly affected than males.[1] After 5 to 15 years of symptoms, the episodes of the world spinning sometimes stop and the person is left with loss of balance, poor hearing in the affected ear, and ringing or other sounds in the affected ear or ears.[5]

Signs and symptoms edit

Ménière's is characterized by recurrent episodes of vertigo, fluctuating hearing loss, and tinnitus; episodes may be preceded by a headache and a feeling of fullness in the ears.[4] People may also experience additional symptoms related to irregular reactions of the autonomic nervous system. These symptoms are not symptoms of Ménière's disease per se, but rather are side effects resulting from failure of the organ of hearing and balance, and include nausea, vomiting, and sweating, which are typically symptoms of vertigo, and not of Ménière's.[1] This includes a sensation of being pushed sharply to the floor from behind.[5] Sudden falls without loss of consciousness (drop attacks) may be experienced by some people.[1]

Causes edit

The cause of Ménière's disease is unclear, but likely involves both genetic and environmental factors.[1][3][7] A number of theories exist including constrictions in blood vessels, viral infections, and autoimmune reactions.[3]

Mechanism edit

 
Inner ear

The initial triggers of Ménière's disease are not fully understood, with a variety of potential inflammatory causes that lead to endolymphatic hydrops, a distension of the endolymphatic spaces in the inner ear. Endolymphatic hydrops is strongly associated with developing Ménière's disease,[1] but not everyone with EH develops Ménière's disease: "The relationship between endolymphatic hydrops and Meniere's disease is not a simple, ideal correlation."[8]

Additionally, in fully developed Ménière's disease, the balance system (vestibular system) and the hearing system (cochlea) of the inner ear are affected, but some cases occur where EH affects only one of the two systems enough to cause symptoms. The corresponding subtypes of the disease are called vestibular Ménière's disease, showing symptoms of vertigo, and cochlear Ménière's disease, showing symptoms of hearing loss and tinnitus.[9][10][11][12]

The mechanism of Ménière's disease is not fully explained by EH, but fully developed EH may mechanically and chemically interfere with the sensory cells for balance and hearing, which can lead to temporary dysfunction and even to death of the sensory cells, which in turn can cause the typical symptoms of MD – vertigo, hearing loss, and tinnitus.[8][10]

An estimated 30% of people with Ménière's disease have Eustachian tube dysfunction.[13]

Diagnosis edit

 
Audiograms illustrating normal hearing (left) and unilateral low-pitch hearing loss associated with Ménière's disease (right)
 
Loudness discomfort levels (LDLs) – data of people with hyperacusis without hearing loss. Upper line: average hearing thresholds. Lower long line: LDLs of this group. Lower short line: LDLs of a reference group with normal hearing.[14]

The diagnostic criteria as of 2015 define definite MD and probable MD as:[1][4]

Definite

  1. Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
  2. Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least one occasion before, during, or after one of the episodes of vertigo
  3. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
  4. Not better accounted for by another vestibular diagnosis

Probable

  1. Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours
  2. Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the reported ear
  3. Not better accounted for by another vestibular diagnosis

A common and important symptom of MD is hypersensitivity to sounds.[15] This hypersensitivity is easily diagnosed by measuring the loudness discomfort levels (LDLs).[16]

Symptoms of MD overlap with migraine-associated vertigo (MAV) in many ways, but when hearing loss develops in MAV, it is usually in both ears, and this is rare in MD, and hearing loss generally does not progress in MAV as it does in MD.[1]

People who have had a transient ischemic attack (TIA) or stroke can present with symptoms similar to MD, and in people at risk magnetic resonance imaging should be conducted to exclude TIA or stroke.[1]

Other vestibular conditions that should be excluded include vestibular paroxysmia, recurrent unilateral vestibulopathy, vestibular schwannoma, or a tumor of the endolymphatic sac.[1]

Management edit

No cure for Ménière's disease is known, but medications, diet, physical therapy, and counseling, and some surgical approaches can be used to manage it.[4] More than 85% of patients with Ménière's disease get better from changes in lifestyle, medical treatment, or minimally invasive surgical procedures. Those procedures include intratympanic steroid therapy, intratympanic gentamicin therapy or endolymphatic sac surgery.[17]

Medications edit

During MD episodes, medications to reduce nausea are used, as are drugs to reduce the anxiety caused by vertigo.[4][18] For longer-term treatment to stop progression, the evidence base is weak for all treatments.[4] Although a causal relation between allergy and Ménière's disease is uncertain, medication to control allergies may be helpful.[19] To assist with vertigo and balance problems, glycopyrrolate has been found to be a useful vestibular suppressant in patients with Ménière's disease.[20]

Diuretics, such as the thiazide-like diuretic chlortalidone, are widely used to manage MD on the theory that it reduces fluid buildup (pressure) in the ear.[21] Based on evidence from multiple but small clinical trials, diuretics appear to be useful for reducing the frequency of episodes of dizziness but do not seem to prevent hearing loss.[22][23]

In cases where hearing loss and continuing severe episodes of vertigo occur, a chemical labyrinthectomy, in which a medication such as gentamicin is injected into the middle ear and kills parts of the vestibular apparatus, may be prescribed.[4][24][25] This treatment has the risk of worsening hearing loss.[24]

Diet edit

People with MD are often advised to reduce their sodium intake.[18][26] Reducing salt intake, however, has not been well studied.[26] Based on the assumption that MD is similar in nature to a migraine, some advise eliminating "migraine triggers" such as caffeine, but the evidence for this is weak.[18] There is no high-quality evidence that changing diet by restricting salt, caffeine or alcohol improves symptoms.[27]

Physical therapy edit

While use of physical therapy early after the onset of MD is probably not useful due to the fluctuating disease course, physical therapy to help retraining of the balance system appears to be useful to reduce both subjective and objective deficits in balance over the longer term.[4][28]

Counseling edit

The psychological distress caused by the vertigo and hearing loss may worsen the condition in some people.[29] Counseling may be useful to manage the distress,[4] as may education and relaxation techniques.[30]

Surgery edit

If symptoms do not improve with less invasive approaches and for cases where the condition is uncontrolled or persistent and affecting both ears, surgery may be considered.[4][18][31]

Endolymphatic sac surgery edit

Surgery to decompress the endolymphatic sac is one surgical approach that is sometimes suggested. Three methods of surgical endolymphatic sac decompression are sometimes suggested – simple decompression, insertion of a shunt, or removal of the sac.[32] There is some very weak evidence that all three methods may be useful for reducing dizziness, but that the level of evidence supporting these surgical procedures is low with further higher quality investigations being suggested.[32] There is a risk in these types of surgical procedures that the shunts used in these surgeries are at risk of becoming displaced or misplaced.[18] For those with severe cases who are eligible for endolymphatic sac decompression, a 2014 systematic review reported that in at least 75% of people, EL sac decompression was effective at controlling vertigo in the short term (>1 year of follow-up) and long term (>24 months).[33]

Ventilation tubes edit

Surgical implantation of eustachian tubes (ventilation tubes) is not strongly supported by medical studies. There are some tentative evidence of benefit from tympanostomy tubes for improvement in the unsteadiness associated with the disease,[13] conclusions about how effective this surgery is and the potential for side effects and harms is not clear.[5][31]

Other surgical interventions edit

Destructive surgeries such as vestibular nerve labyrinthectomy are irreversible and involve removing entire functionality of most, if not all, of the affected ear; as of 2013, almost no evidence existed with which to judge whether these surgeries are effective.[34] The inner ear itself can be surgically removed via labyrinthectomy, although hearing is always completely lost in the affected ear with this operation.[34] The surgeon can also cut the nerve to the balance portion of the inner ear in a vestibular neurectomy. The hearing is often mostly preserved; however, the surgery involves cutting open into the lining of the brain, and a hospital stay of a few days for monitoring is required.[34]

Poorly supported edit

  • As of 2014, betahistine is often used as it is inexpensive and safe;[5] but evidence does not justify its use in Ménière's disease.[35][36]
  • Transtympanic micropressure pulses were investigated in two systematic reviews. Neither found evidence to justify this technique.[37][38]
  • Intratympanic steroids were investigated in three systematic reviews. The data were found to be insufficient to decide if this therapy has positive effects.[39][40][41]
  • Evidence does not support the use of alternative medicine such as acupuncture or herbal supplements.[3]

Prognosis edit

Ménière's disease usually starts confined to one ear; it extends to both ears in about 30% of cases.[5] People may start out with only one symptom, but in Ménière's disease all three appear with time.[5] Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages. Ménière's disease has a course of 5–15 years, and people generally end up with mild disequilibrium, tinnitus, and moderate hearing loss in one ear.[5] As of 2020, there has been no recent major breakthrough in the pathogenesis research of Ménière's disease.[42]

Epidemiology edit

From 3 to 11% of diagnosed dizziness in neuro-otological clinics are due to Ménière's disease.[43] The annual incidence rate is estimated to be about 15 cases per 100,000 people and the prevalence rate is about 218 per 100,000, and around 15% of people with Ménière's disease are older than 65.[43] In around 9% of cases, a relative also had Ménière's disease, indicating a genetic predisposition in some cases.[4]

The odds of Ménière's disease are greater for people of white ethnicity, with severe obesity, and women.[1] Several conditions are often comorbid with Ménière's disease, including arthritis, psoriasis, gastroesophageal reflux disease, irritable bowel syndrome, and migraine.[1]

History edit

The condition is named after the French physician Prosper Menière, who in an 1861 article described the main symptoms and was the first to suggest a single disorder for all of the symptoms, in the combined organ of balance and hearing in the inner ear.[44][45]

The American Academy of Otolaryngology – Head and Neck Surgery Committee on Hearing and Equilibrium set criteria for diagnosing MD, as well as defining two subcategories – cochlear (without vertigo) and vestibular (without deafness).[46]

In 1972, the academy defined criteria for diagnosing MD as:[46]

  1. Fluctuating, progressive, sensorineural deafness
  2. Episodic, characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness, vestibular nystagmus always present.
  3. Tinnitus (ringing in the ears, from mild to severe) is accompanied often by ear pain and a feeling of fullness in the affected ear; usually, the tinnitus is more severe before a spell of vertigo and lessens after the vertigo attack.
  4. Attacks are characterized by periods of remission and exacerbation.

In 1985, this list changed to alter wording, such as changing "deafness" to "hearing loss associated with tinnitus, characteristically of low frequencies" and requiring more than one attack of vertigo to diagnose.[46] Finally in 1995, the list was again altered to allow for degrees of the disease:[46]

  1. Certain – Definite disease with histopathological confirmation
  2. Definite – Requires two or more definitive episodes of vertigo with hearing loss plus tinnitus and/or aural fullness
  3. Probable – Only one definitive episode of vertigo and the other symptoms and signs
  4. Possible – Definitive vertigo with no associated hearing loss

In 2015, the International Classification for Vestibular Disorders Committee of the Barany Society published consensus diagnostic criteria in collaboration with the American Academy of Otolaryngology–Head and Neck Surgery, the European Academy of Otology and Neurootology, the Japan Society for Equilibrium Research, and the Korean Balance Society.[1][4]

References edit

  1. ^ a b c d e f g h i j k l m n o p q r Lopez-Escamez JA, Carey J, Chung WH, et al. (2015). "Diagnostic criteria for Menière's disease". Journal of Vestibular Research: Equilibrium & Orientation. 25 (1): 1–7. doi:10.3233/VES-150549. ISSN 1878-6464. PMID 25882471.
  2. ^ Dictionary.com Unabridged 3 December 2010 at the Wayback Machine (v 1.1). Random House, Inc. Accessed on 9 September 2008
  3. ^ a b c d e f g h i j k l m n o p q r s "Ménière's Disease". NIDCD. 1 June 2016. from the original on 27 July 2016. Retrieved 18 July 2016.
  4. ^ a b c d e f g h i j k l m n o p q r s t u Seemungal B, Kaski D, Lopez-Escamez JA (August 2015). "Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease". Neurologic Clinics. 33 (3): 619–628, ix. doi:10.1016/j.ncl.2015.04.008. ISSN 1557-9875. PMID 26231275.
  5. ^ a b c d e f g h i j k l m Harcourt J, Barraclough K, Bronstein AM (2014). "Meniere's disease". BMJ (Clinical Research Ed.). 349: g6544. doi:10.1136/bmj.g6544. PMID 25391837. S2CID 5099437.
  6. ^ Phillips JS, Westerberg B (6 July 2011). "Intratympanic steroids for Ménière's disease or syndrome". The Cochrane Database of Systematic Reviews (7): CD008514. doi:10.1002/14651858.CD008514.pub2. ISSN 1469-493X. PMID 21735432.
  7. ^ Phillips JS, Westerberg B (6 July 2011). "Intratympanic steroids for Ménière's disease or syndrome". The Cochrane Database of Systematic Reviews (7): CD008514. doi:10.1002/14651858.CD008514.pub2. ISSN 1469-493X. PMID 21735432.
  8. ^ a b Salt AN, Plontke SK (2010). "Endolymphatic hydrops: pathophysiology and experimental models". Otolaryngologic Clinics of North America. 43 (5): 971–983. doi:10.1016/j.otc.2010.05.007. PMC 2923478. PMID 20713237.
  9. ^ . Nidcd.nih.gov (Publication No. 10–3404) (June 1, 2016 ed.). US: National Institutes of Health. July 2010. Archived from the original on 27 July 2016.
  10. ^ a b Gürkov R, Pyykö I, Zou J, Kentala E (2016). "What is Menière's disease? A contemporary re-evaluation of endolymphatic hydrops". Journal of Neurology. 263 (Suppl 1): 71–81. doi:10.1007/s00415-015-7930-1. PMC 4833790. PMID 27083887.
  11. ^ Naganawa S, Nakashima T (2014). "Visualization of endolymphatic hydrops with MR imaging in patients with Ménière's disease and related pathologies: current status of its methods and clinical significance". Japanese Journal of Radiology. 32 (4): 191–204. doi:10.1007/s11604-014-0290-4. PMID 24500139.
  12. ^ Mom T, Pavier Y, Giraudet F, Gilain L, Avan P (2015). "Measurement of endolymphatic pressure". European Annals of Otorhinolaryngology, Head and Neck Diseases. 132 (2): 81–84. doi:10.1016/j.anorl.2014.05.004. PMID 25467202.
  13. ^ a b Walther LE (2005). "Procedures for restoring vestibular disorders". GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 4: Doc05. PMC 3201005. PMID 22073053.
  14. ^ Sheldrake J, Diehl PU, Schaette R (2015). "Audiometric characteristics of hyperacusis patients". Frontiers in Neurology. 6: 105. doi:10.3389/fneur.2015.00105. PMC 4432660. PMID 26029161.
  15. ^ Chi JJ, Ruckenstein MJ (2010). "Chapter 6: Clinical Presentation of Ménière's disease". In Ruckenstein M (ed.). Ménière's disease: evidence and outcomes. San Diego, California Abingdon, England: Plural Publishing, Inc. p. 34. ISBN 978-1-59756-620-9.
  16. ^ Tyler RS, Pienkowski M, Roncancio ER, et al. (2014). (PDF). American Journal of Audiology. 23 (4): 402–419. doi:10.1044/2014_AJA-14-0010. PMID 25104073. Archived from the original (PDF) on 27 June 2017. Retrieved 19 October 2017.
  17. ^ Sajjadi H, Paparella MM (August 2008). "Meniere's disease". Lancet. 372 (9636): 406–414. doi:10.1016/S0140-6736(08)61161-7. PMID 18675691. S2CID 20845192. from the original on 15 December 2022. Retrieved 15 December 2022.
  18. ^ a b c d e Foster CA (2015). "Optimal management of Ménière's disease". Therapeutics and Clinical Risk Management. 11: 301–307. doi:10.2147/TCRM.S59023. ISSN 1176-6336. PMC 4348125. PMID 25750534.
  19. ^ Weinreich HM, Agrawal Y (June 2014). "The Link Between Allergy and Menière's Disease". Current Opinion in Otolaryngology & Head and Neck Surgery. 22 (3): 227–230. doi:10.1097/MOO.0000000000000041. ISSN 1068-9508. PMC 4549154. PMID 24573125.
  20. ^ Storper IS, Spitzer JB, Scanlan M (1998). "Use of glycopyrrolate in the treatment of Meniere's disease". The Laryngoscope. 108 (10): 1442–1445. doi:10.1097/00005537-199810000-00004. PMID 9778280. S2CID 39137575.
  21. ^ Thirlwall AS, Kundu S (19 July 2006). "Diuretics for Ménière's disease or syndrome". The Cochrane Database of Systematic Reviews. 2010 (3): CD003599. doi:10.1002/14651858.CD003599.pub2. ISSN 1469-493X. PMC 9007146. PMID 16856015.
  22. ^ Crowson MG, Patki A, Tucci DL (May 2016). "A Systematic Review of Diuretics in the Medical Management of Ménière's Disease". Otolaryngology–Head and Neck Surgery. 154 (5): 824–834. doi:10.1177/0194599816630733. ISSN 1097-6817. PMID 26932948. S2CID 24741244.
  23. ^ Stern Shavit S, Lalwani AK (2019). "Are diuretics useful in the treatment of meniere disease?". Laryngoscope. 129 (10): 2206–2207. doi:10.1002/lary.28040. PMID 31046134.
  24. ^ a b Pullens B, van Benthem PP (16 March 2011). "Intratympanic gentamicin for Ménière's disease or syndrome". The Cochrane Database of Systematic Reviews (3): CD008234. doi:10.1002/14651858.CD008234.pub2. PMID 21412917.
  25. ^ Huon LK, Fang TY, Wang PC (July 2012). "Outcomes of intratympanic gentamicin injection to treat Ménière's disease". Otology & Neurotology. 33 (5): 706–714. doi:10.1097/MAO.0b013e318259b3b1. PMID 22699980. S2CID 32209105.
  26. ^ a b Espinosa-Sanchez JM, Lopez-Escamez JA (2016). "Menière's disease". Neuro-Otology. Handbook of Clinical Neurology. Vol. 137. pp. 257–277. doi:10.1016/B978-0-444-63437-5.00019-4. ISBN 978-0-444-63437-5. PMID 27638077.
  27. ^ Hussain K, Murdin L, Schilder AG (31 December 2018). "Restriction of salt, caffeine and alcohol intake for the treatment of Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. 2018 (12): CD012173. doi:10.1002/14651858.CD012173.pub2. ISSN 1469-493X. PMC 6516805. PMID 30596397.
  28. ^ Clendaniel RA, Tucci DL (December 1997). "Vestibular rehabilitation strategies in Meniere's disease". Otolaryngologic Clinics of North America. 30 (6): 1145–1158. doi:10.1016/S0030-6665(20)30155-9. ISSN 0030-6665. PMID 9386249.
  29. ^ Orji F (2014). "The Influence of Psychological Factors in Meniere's Disease". Annals of Medical and Health Sciences Research. 4 (1): 3–7. doi:10.4103/2141-9248.126601 (inactive 24 April 2024). ISSN 2141-9248. PMC 3952292. PMID 24669323.{{cite journal}}: CS1 maint: DOI inactive as of April 2024 (link)
  30. ^ Greenberg SL, Nedzelski JM (October 2010). "Medical and noninvasive therapy for Meniere's disease". Otolaryngologic Clinics of North America. 43 (5): 1081–1090. doi:10.1016/j.otc.2010.05.005. ISSN 1557-8259. PMID 20713246.
  31. ^ a b Lee A, Webster KE, George B, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Ray J, Van Vugt VA, Burton MJ (24 February 2023). Cochrane ENT Group (ed.). "Surgical interventions for Ménière's disease". Cochrane Database of Systematic Reviews. 2023 (2): CD015249. doi:10.1002/14651858.CD015249.pub2. PMC 9955726. PMID 36825750.
  32. ^ a b Lim MY, Zhang M, Yuen HW, et al. (November 2015). "Current evidence for endolymphatic sac surgery in the treatment of Meniere's disease: a systematic review". Singapore Medical Journal. 56 (11): 593–598. doi:10.11622/smedj.2015166. ISSN 0037-5675. PMC 4656865. PMID 26668402.
  33. ^ Sood AJ, Lambert PR, Nguyen SA, et al. (July 2014). "Endolymphatic sac surgery for Ménière's disease: a systematic review and meta-analysis". Otology & Neurotology. 35 (6): 1033–1045. doi:10.1097/MAO.0000000000000324. ISSN 1537-4505. PMID 24751747. S2CID 31381271.
  34. ^ a b c Pullens B, Verschuur HP, van Benthem PP (2013). "Surgery for Ménière's disease". The Cochrane Database of Systematic Reviews. 2013 (2): CD005395. doi:10.1002/14651858.CD005395.pub3. ISSN 1469-493X. PMC 7389445. PMID 23450562.
  35. ^ James AL, Burton MJ (2001). "Betahistine for Menière's disease or syndrome". The Cochrane Database of Systematic Reviews. 2020 (1): CD001873. doi:10.1002/14651858.CD001873. ISSN 1469-493X. PMC 6769057. PMID 11279734.
  36. ^ Adrion C, Fischer CS, Wagner J, et al. (2016). "Efficacy and safety of betahistine treatment in patients with Meniere's disease: Primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial)". BMJ. 352: h6816. doi:10.1136/bmj.h6816. PMC 4721211. PMID 26797774.
  37. ^ van Sonsbeek S, Pullens B, van Benthem PP (2015). "Positive pressure therapy for Ménière's disease or syndrome". Cochrane Database Syst Rev. 2015 (3): CD008419. doi:10.1002/14651858.CD008419.pub2. PMC 11026870. PMID 25756795.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Syed MI, Rutka JA, Hendry J, et al. (2015). "Positive pressure therapy for Meniere's syndrome/disease with a Meniett device: A systematic review of randomised controlled trials". Clinical Otolaryngology. 40 (3): 197–207. doi:10.1111/coa.12344. PMID 25346252. S2CID 1025535.
  39. ^ Hu A, Parnes LS (2009). "Intratympanic steroids for inner ear disorders: A review". Audiology and Neurotology. 14 (6): 373–382. doi:10.1159/000241894. PMID 19923807. S2CID 38726308.
  40. ^ Miller MW, Agrawal Y (2014). "Intratympanic Therapies for Menière's disease". Current Otorhinolaryngology Reports. 2 (3): 137–143. doi:10.1007/s40136-014-0055-8. PMC 4157672. PMID 25215266.
  41. ^ Phillips JS, Westerberg B (6 July 2011). "Intratympanic steroids for Ménière's disease or syndrome". The Cochrane Database of Systematic Reviews (7): CD008514. doi:10.1002/14651858.CD008514.pub2. ISSN 1469-493X. PMID 21735432.
  42. ^ Liu Y, Yang J, Duan M (October 2020). "Current status on researches of Meniere's disease: a review". Acta Otolaryngol. 140 (10): 808–812. doi:10.1080/00016489.2020.1776385. PMID 32564698. S2CID 219972013.
  43. ^ a b Iwasaki S, Yamasoba T (February 2015). "Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System". Aging and Disease. 6 (1): 38–47. doi:10.14336/AD.2014.0128. ISSN 2152-5250. PMC 4306472. PMID 25657851.
  44. ^ Ishiyama G, et al. (April 2015). "Meniere's disease: histopathology, cytochemistry, and imaging". Ann N Y Acad Sci. 1343 (1): 49–57. Bibcode:2015NYASA1343...49I. doi:10.1111/nyas.12699. PMID 25766597. S2CID 36495592.
  45. ^ Ménière P (1861). [On a form of severe deafness dependent on a lesion of the inner ear]. Bulletin de l'Académie Impériale de Médecine (in French). 26. republished online at gallica.bnf.fr: 241. Archived from the original on 16 February 2016.
  46. ^ a b c d Beasley NJ, Jones NS (December 1996). "Menière's disease: evolution of a definition". J Laryngol Otol. 110 (12): 1107–1113. doi:10.1017/S002221510013590X. PMID 9015421. S2CID 37842353.

External links edit

  • Basura GJ, Adams ME, Monfared A, et al. (8 April 2020). "Clinical Practice Guideline: Ménière's Disease". Otolaryngology–Head and Neck Surgery. 162 (2 suppl): S1–S55. doi:10.1177/0194599820909438. PMID 32267799.
  • Menière's Disease, Stanford Ear Institute.

ménière, disease, confused, with, ménétrier, disease, disease, inner, that, characterized, potentially, severe, incapacitating, episodes, vertigo, tinnitus, hearing, loss, feeling, fullness, typically, only, affected, initially, over, time, both, ears, become,. Not to be confused with Menetrier s disease Meniere s disease MD is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo tinnitus hearing loss and a feeling of fullness in the ear 3 4 Typically only one ear is affected initially but over time both ears may become involved 3 Episodes generally last from 20 minutes to a few hours 5 The time between episodes varies 3 The hearing loss and ringing in the ears can become constant over time 4 Meniere s diseaseOther namesMeniere s syndrome idiopathic endolymphatic hydrops 1 Diagram of the inner earPronunciation m eɪ n ˈ j ɛer z 2 SpecialtyOtolaryngology NeurologySymptomsFeeling like the world is spinning ringing in the ears hearing loss fullness in the ear 3 4 Usual onset40s 60s 3 Duration20 minutes to few hours per episode 5 CausesUnknown 3 Risk factorsFamily history 4 Diagnostic methodBased on symptoms hearing test 3 Differential diagnosisVestibular migraine transient ischemic attack 1 TreatmentLow salt diet diuretics corticosteroids counselling 3 4 PrognosisAfter 10 years hearing loss and chronic ringing 5 Frequency0 3 1 9 per 1 000 1 The cause of Meniere s disease is unclear but likely involves both genetic and environmental factors 1 3 A number of theories exist for why it occurs including constrictions in blood vessels viral infections and autoimmune reactions 3 About 10 of cases run in families 4 Symptoms are believed to occur as the result of increased fluid buildup in the labyrinth of the inner ear 3 Diagnosis is based on the symptoms and a hearing test 3 Other conditions that may produce similar symptoms include vestibular migraine and transient ischemic attack 1 No cure is known 3 Attacks are often treated with medications to help with the nausea and anxiety 4 Measures to prevent attacks are overall poorly supported by the evidence 4 A low salt diet diuretics and corticosteroids may be tried 4 Physical therapy may help with balance and counselling may help with anxiety 3 4 Injections into the ear or surgery may also be tried if other measures are not effective but are associated with risks 3 5 The use of tympanostomy tubes ventilation tubes to improve vertigo and hearing in people with Meniere s disease is not supported by definitive evidence 5 Meniere s disease was identified in the early 1800s by Prosper Meniere 5 It affects between 0 3 and 1 9 per 1 000 people 1 It typically starts in people 40 to 60 years old 3 6 Females are more commonly affected than males 1 After 5 to 15 years of symptoms the episodes of the world spinning sometimes stop and the person is left with loss of balance poor hearing in the affected ear and ringing or other sounds in the affected ear or ears 5 Contents 1 Signs and symptoms 2 Causes 3 Mechanism 4 Diagnosis 5 Management 5 1 Medications 5 2 Diet 5 3 Physical therapy 5 4 Counseling 5 5 Surgery 5 5 1 Endolymphatic sac surgery 5 5 2 Ventilation tubes 5 5 3 Other surgical interventions 5 6 Poorly supported 6 Prognosis 7 Epidemiology 8 History 9 References 10 External linksSigns and symptoms editMeniere s is characterized by recurrent episodes of vertigo fluctuating hearing loss and tinnitus episodes may be preceded by a headache and a feeling of fullness in the ears 4 People may also experience additional symptoms related to irregular reactions of the autonomic nervous system These symptoms are not symptoms of Meniere s disease per se but rather are side effects resulting from failure of the organ of hearing and balance and include nausea vomiting and sweating which are typically symptoms of vertigo and not of Meniere s 1 This includes a sensation of being pushed sharply to the floor from behind 5 Sudden falls without loss of consciousness drop attacks may be experienced by some people 1 Causes editThe cause of Meniere s disease is unclear but likely involves both genetic and environmental factors 1 3 7 A number of theories exist including constrictions in blood vessels viral infections and autoimmune reactions 3 Mechanism edit nbsp Inner ear The initial triggers of Meniere s disease are not fully understood with a variety of potential inflammatory causes that lead to endolymphatic hydrops a distension of the endolymphatic spaces in the inner ear Endolymphatic hydrops is strongly associated with developing Meniere s disease 1 but not everyone with EH develops Meniere s disease The relationship between endolymphatic hydrops and Meniere s disease is not a simple ideal correlation 8 Additionally in fully developed Meniere s disease the balance system vestibular system and the hearing system cochlea of the inner ear are affected but some cases occur where EH affects only one of the two systems enough to cause symptoms The corresponding subtypes of the disease are called vestibular Meniere s disease showing symptoms of vertigo and cochlear Meniere s disease showing symptoms of hearing loss and tinnitus 9 10 11 12 The mechanism of Meniere s disease is not fully explained by EH but fully developed EH may mechanically and chemically interfere with the sensory cells for balance and hearing which can lead to temporary dysfunction and even to death of the sensory cells which in turn can cause the typical symptoms of MD vertigo hearing loss and tinnitus 8 10 An estimated 30 of people with Meniere s disease have Eustachian tube dysfunction 13 Diagnosis edit nbsp Audiograms illustrating normal hearing left and unilateral low pitch hearing loss associated with Meniere s disease right nbsp Loudness discomfort levels LDLs data of people with hyperacusis without hearing loss Upper line average hearing thresholds Lower long line LDLs of this group Lower short line LDLs of a reference group with normal hearing 14 The diagnostic criteria as of 2015 define definite MD and probable MD as 1 4 DefiniteTwo or more spontaneous episodes of vertigo each lasting 20 minutes to 12 hours Audiometrically documented low to medium frequency sensorineural hearing loss in the affected ear on at least one occasion before during or after one of the episodes of vertigo Fluctuating aural symptoms hearing tinnitus or fullness in the affected ear Not better accounted for by another vestibular diagnosis Probable Two or more episodes of vertigo or dizziness each lasting 20 minutes to 24 hours Fluctuating aural symptoms hearing tinnitus or fullness in the reported ear Not better accounted for by another vestibular diagnosis A common and important symptom of MD is hypersensitivity to sounds 15 This hypersensitivity is easily diagnosed by measuring the loudness discomfort levels LDLs 16 Symptoms of MD overlap with migraine associated vertigo MAV in many ways but when hearing loss develops in MAV it is usually in both ears and this is rare in MD and hearing loss generally does not progress in MAV as it does in MD 1 People who have had a transient ischemic attack TIA or stroke can present with symptoms similar to MD and in people at risk magnetic resonance imaging should be conducted to exclude TIA or stroke 1 Other vestibular conditions that should be excluded include vestibular paroxysmia recurrent unilateral vestibulopathy vestibular schwannoma or a tumor of the endolymphatic sac 1 Management editNo cure for Meniere s disease is known but medications diet physical therapy and counseling and some surgical approaches can be used to manage it 4 More than 85 of patients with Meniere s disease get better from changes in lifestyle medical treatment or minimally invasive surgical procedures Those procedures include intratympanic steroid therapy intratympanic gentamicin therapy or endolymphatic sac surgery 17 Medications edit During MD episodes medications to reduce nausea are used as are drugs to reduce the anxiety caused by vertigo 4 18 For longer term treatment to stop progression the evidence base is weak for all treatments 4 Although a causal relation between allergy and Meniere s disease is uncertain medication to control allergies may be helpful 19 To assist with vertigo and balance problems glycopyrrolate has been found to be a useful vestibular suppressant in patients with Meniere s disease 20 Diuretics such as the thiazide like diuretic chlortalidone are widely used to manage MD on the theory that it reduces fluid buildup pressure in the ear 21 Based on evidence from multiple but small clinical trials diuretics appear to be useful for reducing the frequency of episodes of dizziness but do not seem to prevent hearing loss 22 23 In cases where hearing loss and continuing severe episodes of vertigo occur a chemical labyrinthectomy in which a medication such as gentamicin is injected into the middle ear and kills parts of the vestibular apparatus may be prescribed 4 24 25 This treatment has the risk of worsening hearing loss 24 Diet edit People with MD are often advised to reduce their sodium intake 18 26 Reducing salt intake however has not been well studied 26 Based on the assumption that MD is similar in nature to a migraine some advise eliminating migraine triggers such as caffeine but the evidence for this is weak 18 There is no high quality evidence that changing diet by restricting salt caffeine or alcohol improves symptoms 27 Physical therapy edit While use of physical therapy early after the onset of MD is probably not useful due to the fluctuating disease course physical therapy to help retraining of the balance system appears to be useful to reduce both subjective and objective deficits in balance over the longer term 4 28 Counseling edit The psychological distress caused by the vertigo and hearing loss may worsen the condition in some people 29 Counseling may be useful to manage the distress 4 as may education and relaxation techniques 30 Surgery edit If symptoms do not improve with less invasive approaches and for cases where the condition is uncontrolled or persistent and affecting both ears surgery may be considered 4 18 31 Endolymphatic sac surgery edit Surgery to decompress the endolymphatic sac is one surgical approach that is sometimes suggested Three methods of surgical endolymphatic sac decompression are sometimes suggested simple decompression insertion of a shunt or removal of the sac 32 There is some very weak evidence that all three methods may be useful for reducing dizziness but that the level of evidence supporting these surgical procedures is low with further higher quality investigations being suggested 32 There is a risk in these types of surgical procedures that the shunts used in these surgeries are at risk of becoming displaced or misplaced 18 For those with severe cases who are eligible for endolymphatic sac decompression a 2014 systematic review reported that in at least 75 of people EL sac decompression was effective at controlling vertigo in the short term gt 1 year of follow up and long term gt 24 months 33 Ventilation tubes edit Surgical implantation of eustachian tubes ventilation tubes is not strongly supported by medical studies There are some tentative evidence of benefit from tympanostomy tubes for improvement in the unsteadiness associated with the disease 13 conclusions about how effective this surgery is and the potential for side effects and harms is not clear 5 31 Other surgical interventions edit Destructive surgeries such as vestibular nerve labyrinthectomy are irreversible and involve removing entire functionality of most if not all of the affected ear as of 2013 almost no evidence existed with which to judge whether these surgeries are effective 34 The inner ear itself can be surgically removed via labyrinthectomy although hearing is always completely lost in the affected ear with this operation 34 The surgeon can also cut the nerve to the balance portion of the inner ear in a vestibular neurectomy The hearing is often mostly preserved however the surgery involves cutting open into the lining of the brain and a hospital stay of a few days for monitoring is required 34 Poorly supported edit As of 2014 betahistine is often used as it is inexpensive and safe 5 but evidence does not justify its use in Meniere s disease 35 36 Transtympanic micropressure pulses were investigated in two systematic reviews Neither found evidence to justify this technique 37 38 Intratympanic steroids were investigated in three systematic reviews The data were found to be insufficient to decide if this therapy has positive effects 39 40 41 Evidence does not support the use of alternative medicine such as acupuncture or herbal supplements 3 Prognosis editMeniere s disease usually starts confined to one ear it extends to both ears in about 30 of cases 5 People may start out with only one symptom but in Meniere s disease all three appear with time 5 Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages Meniere s disease has a course of 5 15 years and people generally end up with mild disequilibrium tinnitus and moderate hearing loss in one ear 5 As of 2020 there has been no recent major breakthrough in the pathogenesis research of Meniere s disease 42 Epidemiology editFrom 3 to 11 of diagnosed dizziness in neuro otological clinics are due to Meniere s disease 43 The annual incidence rate is estimated to be about 15 cases per 100 000 people and the prevalence rate is about 218 per 100 000 and around 15 of people with Meniere s disease are older than 65 43 In around 9 of cases a relative also had Meniere s disease indicating a genetic predisposition in some cases 4 The odds of Meniere s disease are greater for people of white ethnicity with severe obesity and women 1 Several conditions are often comorbid with Meniere s disease including arthritis psoriasis gastroesophageal reflux disease irritable bowel syndrome and migraine 1 History editThe condition is named after the French physician Prosper Meniere who in an 1861 article described the main symptoms and was the first to suggest a single disorder for all of the symptoms in the combined organ of balance and hearing in the inner ear 44 45 The American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium set criteria for diagnosing MD as well as defining two subcategories cochlear without vertigo and vestibular without deafness 46 In 1972 the academy defined criteria for diagnosing MD as 46 Fluctuating progressive sensorineural deafness Episodic characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness vestibular nystagmus always present Tinnitus ringing in the ears from mild to severe is accompanied often by ear pain and a feeling of fullness in the affected ear usually the tinnitus is more severe before a spell of vertigo and lessens after the vertigo attack Attacks are characterized by periods of remission and exacerbation In 1985 this list changed to alter wording such as changing deafness to hearing loss associated with tinnitus characteristically of low frequencies and requiring more than one attack of vertigo to diagnose 46 Finally in 1995 the list was again altered to allow for degrees of the disease 46 Certain Definite disease with histopathological confirmation Definite Requires two or more definitive episodes of vertigo with hearing loss plus tinnitus and or aural fullness Probable Only one definitive episode of vertigo and the other symptoms and signs Possible Definitive vertigo with no associated hearing loss In 2015 the International Classification for Vestibular Disorders Committee of the Barany Society published consensus diagnostic criteria in collaboration with the American Academy of Otolaryngology Head and Neck Surgery the European Academy of Otology and Neurootology the Japan Society for Equilibrium Research and the Korean Balance Society 1 4 References edit a b c d e f g h i j k l m n o p q r Lopez Escamez JA Carey J Chung WH et al 2015 Diagnostic criteria for Meniere s disease Journal of Vestibular Research Equilibrium amp Orientation 25 1 1 7 doi 10 3233 VES 150549 ISSN 1878 6464 PMID 25882471 Dictionary com Unabridged Archived 3 December 2010 at the Wayback Machine v 1 1 Random House Inc Accessed on 9 September 2008 a b c d e f g h i j k l m n o p q r s Meniere s Disease NIDCD 1 June 2016 Archived from the original on 27 July 2016 Retrieved 18 July 2016 a b c d e f g h i j k l m n o p q r s t u Seemungal B Kaski D Lopez Escamez JA August 2015 Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Meniere s Disease Neurologic Clinics 33 3 619 628 ix doi 10 1016 j ncl 2015 04 008 ISSN 1557 9875 PMID 26231275 a b c d e f g h i j k l m Harcourt J Barraclough K Bronstein AM 2014 Meniere s disease BMJ Clinical Research Ed 349 g6544 doi 10 1136 bmj g6544 PMID 25391837 S2CID 5099437 Phillips JS Westerberg B 6 July 2011 Intratympanic steroids for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 7 CD008514 doi 10 1002 14651858 CD008514 pub2 ISSN 1469 493X PMID 21735432 Phillips JS Westerberg B 6 July 2011 Intratympanic steroids for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 7 CD008514 doi 10 1002 14651858 CD008514 pub2 ISSN 1469 493X PMID 21735432 a b Salt AN Plontke SK 2010 Endolymphatic hydrops pathophysiology and experimental models Otolaryngologic Clinics of North America 43 5 971 983 doi 10 1016 j otc 2010 05 007 PMC 2923478 PMID 20713237 Meniere s Disease Nidcd nih gov Publication No 10 3404 June 1 2016 ed US National Institutes of Health July 2010 Archived from the original on 27 July 2016 a b Gurkov R Pyyko I Zou J Kentala E 2016 What is Meniere s disease A contemporary re evaluation of endolymphatic hydrops Journal of Neurology 263 Suppl 1 71 81 doi 10 1007 s00415 015 7930 1 PMC 4833790 PMID 27083887 Naganawa S Nakashima T 2014 Visualization of endolymphatic hydrops with MR imaging in patients with Meniere s disease and related pathologies current status of its methods and clinical significance Japanese Journal of Radiology 32 4 191 204 doi 10 1007 s11604 014 0290 4 PMID 24500139 Mom T Pavier Y Giraudet F Gilain L Avan P 2015 Measurement of endolymphatic pressure European Annals of Otorhinolaryngology Head and Neck Diseases 132 2 81 84 doi 10 1016 j anorl 2014 05 004 PMID 25467202 a b Walther LE 2005 Procedures for restoring vestibular disorders GMS Current Topics in Otorhinolaryngology Head and Neck Surgery 4 Doc05 PMC 3201005 PMID 22073053 Sheldrake J Diehl PU Schaette R 2015 Audiometric characteristics of hyperacusis patients Frontiers in Neurology 6 105 doi 10 3389 fneur 2015 00105 PMC 4432660 PMID 26029161 Chi JJ Ruckenstein MJ 2010 Chapter 6 Clinical Presentation of Meniere s disease In Ruckenstein M ed Meniere s disease evidence and outcomes San Diego California Abingdon England Plural Publishing Inc p 34 ISBN 978 1 59756 620 9 Tyler RS Pienkowski M Roncancio ER et al 2014 A review of hyperacusis and future directions part I Definitions and manifestations PDF American Journal of Audiology 23 4 402 419 doi 10 1044 2014 AJA 14 0010 PMID 25104073 Archived from the original PDF on 27 June 2017 Retrieved 19 October 2017 Sajjadi H Paparella MM August 2008 Meniere s disease Lancet 372 9636 406 414 doi 10 1016 S0140 6736 08 61161 7 PMID 18675691 S2CID 20845192 Archived from the original on 15 December 2022 Retrieved 15 December 2022 a b c d e Foster CA 2015 Optimal management of Meniere s disease Therapeutics and Clinical Risk Management 11 301 307 doi 10 2147 TCRM S59023 ISSN 1176 6336 PMC 4348125 PMID 25750534 Weinreich HM Agrawal Y June 2014 The Link Between Allergy and Meniere s Disease Current Opinion in Otolaryngology amp Head and Neck Surgery 22 3 227 230 doi 10 1097 MOO 0000000000000041 ISSN 1068 9508 PMC 4549154 PMID 24573125 Storper IS Spitzer JB Scanlan M 1998 Use of glycopyrrolate in the treatment of Meniere s disease The Laryngoscope 108 10 1442 1445 doi 10 1097 00005537 199810000 00004 PMID 9778280 S2CID 39137575 Thirlwall AS Kundu S 19 July 2006 Diuretics for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 2010 3 CD003599 doi 10 1002 14651858 CD003599 pub2 ISSN 1469 493X PMC 9007146 PMID 16856015 Crowson MG Patki A Tucci DL May 2016 A Systematic Review of Diuretics in the Medical Management of Meniere s Disease Otolaryngology Head and Neck Surgery 154 5 824 834 doi 10 1177 0194599816630733 ISSN 1097 6817 PMID 26932948 S2CID 24741244 Stern Shavit S Lalwani AK 2019 Are diuretics useful in the treatment of meniere disease Laryngoscope 129 10 2206 2207 doi 10 1002 lary 28040 PMID 31046134 a b Pullens B van Benthem PP 16 March 2011 Intratympanic gentamicin for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 3 CD008234 doi 10 1002 14651858 CD008234 pub2 PMID 21412917 Huon LK Fang TY Wang PC July 2012 Outcomes of intratympanic gentamicin injection to treat Meniere s disease Otology amp Neurotology 33 5 706 714 doi 10 1097 MAO 0b013e318259b3b1 PMID 22699980 S2CID 32209105 a b Espinosa Sanchez JM Lopez Escamez JA 2016 Meniere s disease Neuro Otology Handbook of Clinical Neurology Vol 137 pp 257 277 doi 10 1016 B978 0 444 63437 5 00019 4 ISBN 978 0 444 63437 5 PMID 27638077 Hussain K Murdin L Schilder AG 31 December 2018 Restriction of salt caffeine and alcohol intake for the treatment of Meniere s disease or syndrome Cochrane Database of Systematic Reviews 2018 12 CD012173 doi 10 1002 14651858 CD012173 pub2 ISSN 1469 493X PMC 6516805 PMID 30596397 Clendaniel RA Tucci DL December 1997 Vestibular rehabilitation strategies in Meniere s disease Otolaryngologic Clinics of North America 30 6 1145 1158 doi 10 1016 S0030 6665 20 30155 9 ISSN 0030 6665 PMID 9386249 Orji F 2014 The Influence of Psychological Factors in Meniere s Disease Annals of Medical and Health Sciences Research 4 1 3 7 doi 10 4103 2141 9248 126601 inactive 24 April 2024 ISSN 2141 9248 PMC 3952292 PMID 24669323 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint DOI inactive as of April 2024 link Greenberg SL Nedzelski JM October 2010 Medical and noninvasive therapy for Meniere s disease Otolaryngologic Clinics of North America 43 5 1081 1090 doi 10 1016 j otc 2010 05 005 ISSN 1557 8259 PMID 20713246 a b Lee A Webster KE George B Harrington Benton NA Judd O Kaski D Maarsingh OR MacKeith S Ray J Van Vugt VA Burton MJ 24 February 2023 Cochrane ENT Group ed Surgical interventions for Meniere s disease Cochrane Database of Systematic Reviews 2023 2 CD015249 doi 10 1002 14651858 CD015249 pub2 PMC 9955726 PMID 36825750 a b Lim MY Zhang M Yuen HW et al November 2015 Current evidence for endolymphatic sac surgery in the treatment of Meniere s disease a systematic review Singapore Medical Journal 56 11 593 598 doi 10 11622 smedj 2015166 ISSN 0037 5675 PMC 4656865 PMID 26668402 Sood AJ Lambert PR Nguyen SA et al July 2014 Endolymphatic sac surgery for Meniere s disease a systematic review and meta analysis Otology amp Neurotology 35 6 1033 1045 doi 10 1097 MAO 0000000000000324 ISSN 1537 4505 PMID 24751747 S2CID 31381271 a b c Pullens B Verschuur HP van Benthem PP 2013 Surgery for Meniere s disease The Cochrane Database of Systematic Reviews 2013 2 CD005395 doi 10 1002 14651858 CD005395 pub3 ISSN 1469 493X PMC 7389445 PMID 23450562 James AL Burton MJ 2001 Betahistine for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 2020 1 CD001873 doi 10 1002 14651858 CD001873 ISSN 1469 493X PMC 6769057 PMID 11279734 Adrion C Fischer CS Wagner J et al 2016 Efficacy and safety of betahistine treatment in patients with Meniere s disease Primary results of a long term multicentre double blind randomised placebo controlled dose defining trial BEMED trial BMJ 352 h6816 doi 10 1136 bmj h6816 PMC 4721211 PMID 26797774 van Sonsbeek S Pullens B van Benthem PP 2015 Positive pressure therapy for Meniere s disease or syndrome Cochrane Database Syst Rev 2015 3 CD008419 doi 10 1002 14651858 CD008419 pub2 PMC 11026870 PMID 25756795 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint multiple names authors list link Syed MI Rutka JA Hendry J et al 2015 Positive pressure therapy for Meniere s syndrome disease with a Meniett device A systematic review of randomised controlled trials Clinical Otolaryngology 40 3 197 207 doi 10 1111 coa 12344 PMID 25346252 S2CID 1025535 Hu A Parnes LS 2009 Intratympanic steroids for inner ear disorders A review Audiology and Neurotology 14 6 373 382 doi 10 1159 000241894 PMID 19923807 S2CID 38726308 Miller MW Agrawal Y 2014 Intratympanic Therapies for Meniere s disease Current Otorhinolaryngology Reports 2 3 137 143 doi 10 1007 s40136 014 0055 8 PMC 4157672 PMID 25215266 Phillips JS Westerberg B 6 July 2011 Intratympanic steroids for Meniere s disease or syndrome The Cochrane Database of Systematic Reviews 7 CD008514 doi 10 1002 14651858 CD008514 pub2 ISSN 1469 493X PMID 21735432 Liu Y Yang J Duan M October 2020 Current status on researches of Meniere s disease a review Acta Otolaryngol 140 10 808 812 doi 10 1080 00016489 2020 1776385 PMID 32564698 S2CID 219972013 a b Iwasaki S Yamasoba T February 2015 Dizziness and Imbalance in the Elderly Age related Decline in the Vestibular System Aging and Disease 6 1 38 47 doi 10 14336 AD 2014 0128 ISSN 2152 5250 PMC 4306472 PMID 25657851 Ishiyama G et al April 2015 Meniere s disease histopathology cytochemistry and imaging Ann N Y Acad Sci 1343 1 49 57 Bibcode 2015NYASA1343 49I doi 10 1111 nyas 12699 PMID 25766597 S2CID 36495592 Meniere P 1861 Sur une forme de surdite grave dependant d une lesion de l oreille interne On a form of severe deafness dependent on a lesion of the inner ear Bulletin de l Academie Imperiale de Medecine in French 26 republished online at gallica bnf fr 241 Archived from the original on 16 February 2016 a b c d Beasley NJ Jones NS December 1996 Meniere s disease evolution of a definition J Laryngol Otol 110 12 1107 1113 doi 10 1017 S002221510013590X PMID 9015421 S2CID 37842353 External links edit nbsp Wikimedia Commons has media related to Meniere s disease Basura GJ Adams ME Monfared A et al 8 April 2020 Clinical Practice Guideline Meniere s Disease Otolaryngology Head and Neck Surgery 162 2 suppl S1 S55 doi 10 1177 0194599820909438 PMID 32267799 Meniere s Disease Stanford Ear Institute Retrieved from https en wikipedia org w index php title Meniere 27s disease amp oldid 1220599986, wikipedia, wiki, book, books, library,

article

, read, download, free, free download, mp3, video, mp4, 3gp, jpg, jpeg, gif, png, picture, music, song, movie, book, game, games.