View source for Ménière's disease

{{short description|Disorder of the inner ear}}
{{distinguish|Ménétrier's disease}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=December 2014}}
{{Infobox medical condition
| name            = Ménière's disease
| image           = Balance Disorder Illustration A.png
| caption         = Diagram of the inner ear
| pronounce       = {{IPAc-en|m|eɪ|n|ˈ|j|ɛər|z}}<ref>''[http://dictionary.reference.com/browse/meniere%27s%20syndrome Dictionary.com Unabridged] {{webarchive|url=https://web.archive.org/web/20101203141359/http://dictionary.reference.com/browse/meniere%27s%20syndrome |date=3 December 2010 }}'' (v 1.1). Random House, Inc. Accessed on 9 September 2008</ref>
| synonyms        = Ménière's syndrome, idiopathic [[endolymphatic hydrops]]<ref name=Con2015/>
| field           = [[Otolaryngology]], [[Neurology]]
| symptoms        = [[Vertigo]], [[tinnitus]], [[hearing loss]], fullness in the ear<ref name=NIH2016/><ref name=See2016/>
| complications   = 
| onset           = 40s–60s<ref name=NIH2016/>
| duration        = 20 minutes to few hours per episode<ref name=Har2014/>
| causes          = Unknown<ref name=NIH2016/>
| risks           = Family history<ref name=See2016/>
| diagnosis       = Based on symptoms, [[hearing test]]<ref name=NIH2016/>
| differential    = [[Vestibular migraine]], [[transient ischemic attack]]<ref name=Con2015/>
| prevention      = 
| treatment       = Low-salt diet, [[diuretic]]s, [[corticosteroid]]s, counselling<ref name=NIH2016/><ref name=See2016/>
| medication      = 
| prognosis       = After ~10 years [[hearing loss]] and chronic ringing<ref name=Har2014/>
| frequency       = 0.3–1.9 per 1,000<ref name=Con2015/>
| deaths          = 
}}
<!-- Definition and symptoms -->

'''Ménière's disease''' ('''MD''') is a disease of the [[inner ear]] characterized by potentially severe and incapacitating episodes of [[vertigo]], [[tinnitus]], [[hearing loss]], and a feeling of fullness in the ear.<ref name="NIH2016" /><ref name="See2016" /> Typically, only one ear is affected initially, but over time, both ears may become involved.<ref name="NIH2016" /> Episodes generally last from 20 minutes to a few hours,<ref name="Har2014">{{cite journal |vauthors=Harcourt J, Barraclough K, Bronstein AM |title=Meniere's disease |journal=BMJ (Clinical Research Ed.) |volume=349 |article-number=g6544 |year=2014 |pmid=25391837 |doi= 10.1136/bmj.g6544|s2cid=5099437 }}</ref> with varying time between episodes.<ref name="NIH2016" /> The hearing loss and ringing in the ears can become constant over time.<ref name="See2016" /> Ménière's disease was identified in the early 1800s by [[Prosper Menière]].<ref name="Har2014" />

<!-- Cause and diagnosis -->
The cause of Ménière's disease is [[idiopathic disease|unclear]], but likely involves both genetic and environmental factors.<ref name=Con2015/><ref name=NIH2016>{{cite web |title= Ménière's Disease|url=https://www.nidcd.nih.gov/health/menieres-disease|website=NIDCD|access-date=18 July 2016|date=June 1, 2016|url-status= live |archive-url= https://web.archive.org/web/20160727231318/https://www.nidcd.nih.gov/health/menieres-disease|archive-date=27 July 2016}}</ref> A number of theories exist for why it occurs, including constrictions in blood vessels, viral infections, and autoimmune reactions.<ref name=NIH2016/> About 10% of cases run in families.<ref name= See2016>{{Cite journal | last1=Seemungal|first1=Barry|last2=Kaski|first2=Diego|last3=Lopez-Escamez|first3=Jose Antonio|date=August 2015|title=Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease|journal=Neurologic Clinics|volume=33|issue=3|pages=619–628, ix|doi=10.1016/j.ncl.2015.04.008|issn=1557-9875|pmid=26231275}}</ref> Symptoms are believed to occur as the result of increased fluid buildup in the [[Membranous labyrinth|labyrinth]] of the inner ear.<ref name=NIH2016/> Diagnosis is based on the symptoms and a [[hearing test]].<ref name=NIH2016/> Other conditions that may produce similar symptoms include [[vestibular migraine]] and [[transient ischemic attack]].<ref name=Con2015>{{Cite journal| display-authors= 3| last1=Lopez-Escamez|first1=Jose A.|last2=Carey|first2=John|last3=Chung|first3=Won-Ho|last4=Goebel|first4=Joel A.| last5= Magnusson |first5= Måns| last6=Mandalà|first6=Marco|last7=Newman-Toker|first7=David E.|last8=Strupp|first8=Michael|last9=Suzuki|first9=Mamoru|date=2015|title=Diagnostic criteria for Menière's disease|journal=Journal of Vestibular Research: Equilibrium & Orientation|volume=25|issue=1|pages=1–7|doi=10.3233/VES-150549|issn=1878-6464|pmid=25882471|doi-access=free}}</ref>

<!-- Treatment -->
No cure is known.<ref name=NIH2016/> Attacks are often treated with medications to help with the [[nausea]] and [[anxiety]].<ref name=See2016/> Measures to prevent attacks are overall poorly supported by the evidence.<ref name=See2016/> A [[Low sodium diet|low-salt diet]], [[diuretic]]s, and [[corticosteroid]]s may be tried.<ref name=See2016/> [[Physical therapy]] may help with balance and [[cognitive behavioral therapy|counselling]] may help with anxiety.<ref name=NIH2016/><ref name=See2016/> Injections into the ear or surgery may also be tried if other measures are not effective, but are associated with risks.<ref name=NIH2016/><ref name=Har2014/> The use of [[tympanostomy tube]]s (ventilation tubes) to improve vertigo and hearing in people with Ménière's disease is not supported by definitive evidence.<ref name=Har2014/>

<!-- Epidemiology, and prognosis -->
The disease affects between 0.3 and 1.9 per 1,000 people.<ref name=Con2015/> The onset of Ménière's disease is usually around 40 to 60 years old.<ref name=NIH2016/><ref>{{Cite journal|last1=Phillips|first1=John S.|last2=Westerberg|first2=Brian|date=2011-07-06|title=Intratympanic steroids for Ménière's disease or syndrome|journal=The Cochrane Database of Systematic Reviews|issue=7|article-number=CD008514|doi=10.1002/14651858.CD008514.pub2|issn=1469-493X|pmid=21735432}}</ref> Females are more commonly affected than males.<ref name=Con2015/> After 5–15 years of symptoms, episodes that include dizziness or a sensation of 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.<ref name=Har2014/>
{{TOC limit|3}}

== Signs and symptoms ==
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.<ref name=See2016/> 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.<ref name=Con2015/> This includes a sensation of being pushed sharply to the floor from behind.<ref name=Har2014/> Sudden falls without loss of consciousness ([[drop attack]]s) may be experienced by some people.<ref name=Con2015/>

== Causes ==
The cause of Ménière's disease is unclear, but likely involves both genetic and environmental factors.<ref name=Con2015/><ref name=NIH2016/><ref>{{Cite journal |last1= Phillips |first1= John S.|last2=Westerberg|first2=Brian|date=2011-07-06|title=Intratympanic steroids for Ménière's disease or syndrome|journal=The Cochrane Database of Systematic Reviews| issue= 7|article-number=CD008514|doi=10.1002/14651858.CD008514.pub2|issn=1469-493X|pmid=21735432}}</ref> A number of theories exist including constrictions in blood vessels, viral infections, and autoimmune reactions.<ref name=NIH2016/>

==Mechanism==
[[Image:Vestibular system's semicircular canal- a cross-section.jpg|thumb|upright=1.4|[[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]] (EH), a distension of the [[endolymph]]atic spaces in the inner ear. Endolymphatic hydrops is strongly associated with developing Ménière's disease,<ref name=Con2015/> but not everyone with EH develops Ménière's disease: "The relationship between endolymphatic hydrops and Meniere's disease is not a simple, ideal correlation."<ref name= Salt2010Rev/> Notably, mild EH can also occur in [[vestibular migraine]] which is an important differential diagnosis for Ménière's disease.<ref name="DOI10.1136/jnnp-2024-334419">V. Kirsch, Rainer Boegle, J. Gerb, E. Kierig, Birgit Ertl‐Wagner, Sandra Becker‐Bense, Thomas Brandt, Marianne Dieterich: ''Imaging endolymphatic space of the inner ear in vestibular migraine.'' In: ''Journal of Neurology Neurosurgery & Psychiatry.'' 2024, S.&nbsp;jnnp–334419 {{doi|10.1136/jnnp-2024-334419}}.</ref>

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.<ref>{{cite journal| url= https://www.nidcd.nih.gov/health/menieres-disease |publisher= National Institutes of Health |location= US| title= Ménière's Disease| journal= Nidcd.nih.gov| number= Publication No. 10–3404|date= July 2010| edition= June 1, 2016 |archive-url= https://web.archive.org/web/20160727231318/https://www.nidcd.nih.gov/health/menieres-disease |archive-date=27 July 2016 }}</ref><ref name= Gurkov2016rev>{{cite journal | vauthors = Gürkov R, Pyykö I, Zou J, Kentala E | title = What is Menière's disease? A contemporary re-evaluation of endolymphatic hydrops | journal = Journal of Neurology | volume = 263 | pages = 71–81 | year = 2016 | issue = Suppl 1 | pmid = 27083887 | pmc = 4833790 | doi = 10.1007/s00415-015-7930-1 }}</ref><ref name=Naganawa2014rev>{{cite journal | vauthors = Naganawa S, Nakashima T | title = Visualization of endolymphatic hydrops with MR imaging in patients with Ménière's disease and related pathologies: current status of its methods and clinical significance | journal = Japanese Journal of Radiology | volume = 32 | issue = 4 | pages = 191–204 | year = 2014 | pmid = 24500139 | doi = 10.1007/s11604-014-0290-4 | doi-access = free }}</ref><ref name= Mom2015Rev>{{cite journal | vauthors = Mom T, Pavier Y, Giraudet F, Gilain L, Avan P | title = Measurement of endolymphatic pressure | journal = European Annals of Otorhinolaryngology, Head and Neck Diseases | volume = 132 | issue = 2 | pages = 81–84 | year = 2015 | pmid = 25467202 | doi = 10.1016/j.anorl.2014.05.004 | doi-access = free }}</ref>

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.<ref name= Salt2010Rev>{{cite journal | vauthors = Salt AN, Plontke SK | title = Endolymphatic hydrops: pathophysiology and experimental models | journal = Otolaryngologic Clinics of North America | volume = 43 | issue = 5 | pages = 971–983 | year = 2010 | pmid = 20713237 | pmc = 2923478 | doi = 10.1016/j.otc.2010.05.007 }}</ref><ref name= Gurkov2016rev/>

An estimated 30% of people with Ménière's disease have [[Eustachian tube dysfunction]].<ref name="Walther2005Rev">{{cite journal |vauthors=Walther LE |year=2005 |title=Procedures for restoring vestibular disorders |journal=GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery |volume=4 |pages=Doc05 |pmc=3201005 |pmid=22073053}}</ref>

== Diagnosis ==
[[File:Menieres-hearing-loss.png|thumb|right|upright=1.4|[[Audiogram]]s illustrating normal hearing (left) and unilateral low-pitch hearing loss associated with Ménière's disease (right)]]
[[File:LDL-Audiogram.jpg|thumb|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.<ref name="pmid26029161">{{cite journal | vauthors = Sheldrake J, Diehl PU, Schaette R | title = Audiometric characteristics of hyperacusis patients | journal = Frontiers in Neurology | volume = 6 | page = 105 | year = 2015 | pmid = 26029161 | pmc = 4432660 | doi = 10.3389/fneur.2015.00105 | doi-access = free }}</ref>]]

The diagnostic criteria as of 2015 define definite MD and probable MD as:<ref name=Con2015/><ref name=See2016/>

<blockquote>'''Definite'''
# Two 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</blockquote>

A common and important symptom of MD is [[hyperacusis|hypersensitivity to sounds]].<ref name="Ruckenstein 2010 p. ">{{cite book | editor1-last=Ruckenstein | editor1-first=Michael | title=Ménière's disease: evidence and outcomes | publisher=Plural Publishing, Inc | location=San Diego, California Abingdon, England | year=2010 | isbn=978-1-59756-620-9 | page=34|chapter=Chapter 6: Clinical Presentation of Ménière's disease|last1=Chi|first1=John J.|last2=Ruckenstein|first2=Michael J.}}</ref> This hypersensitivity is easily diagnosed by measuring the loudness discomfort levels (LDLs).<ref name="pmid25104073">{{cite journal | vauthors = Tyler RS, Pienkowski M, Roncancio ER, et al. | title = A review of hyperacusis and future directions: part I. Definitions and manifestations | journal = American Journal of Audiology | volume = 23 | issue = 4 | pages = 402–419 | year = 2014 | pmid = 25104073 | doi = 10.1044/2014_AJA-14-0010 | url = http://www.hyperacusis.net/media/1375/hyperacusis-part-1.pdf | access-date = 19 October 2017 | archive-date = 27 June 2017 | archive-url = https://web.archive.org/web/20170627223134/http://www.hyperacusis.net/media/1375/hyperacusis-part-1.pdf }}</ref>

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.<ref name=Con2015/>

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]] <!-- (MRI) --> should be conducted to exclude TIA or stroke.<ref name=Con2015/>

Other vestibular conditions that should be excluded include [[vestibular paroxysmia]], [[recurrent unilateral vestibulopathy]], [[vestibular schwannoma]], or a tumor of the [[endolymphatic sac]].<ref name=Con2015/>

== Management ==
No cure for Ménière's disease is known, but medications, diet, physical therapy, counseling, and some surgical approaches can be used to manage it.<ref name=See2016/> 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 (into the cavity behind the eardrum, known as the [[tympanic cavity]]) [[steroid]] therapy, intratympanic [[gentamicin]] therapy or [[endolymphatic sac|endolymphatic sac surgery]].<ref name="pmid18675691">{{cite journal |vauthors=Sajjadi H, Paparella MM |title=Meniere's disease |journal=Lancet |volume=372 |issue=9636 |pages=406–414 |date=August 2008 |pmid=18675691 |doi=10.1016/S0140-6736(08)61161-7 |s2cid=20845192 }}</ref>

=== Medications ===
During MD episodes, [[antiemetics|medications to reduce nausea]] are used, as are [[anxiolytics|drugs to reduce the anxiety]] caused by vertigo.<ref name=See2016/><ref name=Foster2015rev/> For longer-term treatment to stop progression, the evidence base is weak for all treatments.<ref name=See2016/> Although a causal relation between allergy and Ménière's disease is uncertain, [[Allergy#Management|medication to control allergies]] may be helpful.<ref name="Allergy2014rev">{{Cite journal|last1=Weinreich|first1=Heather M.| last2= Agrawal|first2=Yuri|date=June 2014|title=The Link Between Allergy and Menière's Disease|journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume= 22 |issue= 3|pages=227–230|doi=10.1097/MOO.0000000000000041|issn=1068-9508|pmc=4549154|pmid=24573125}}</ref> To assist with vertigo and balance problems, [[glycopyrrolate]] has been found to be a useful vestibular suppressant in patients with Ménière's disease.<ref name= storper108-10>{{Cite journal |pmid = 9778280|year = 1998|last1 = Storper|first1 = Ian S.|last2 = Spitzer|first2 = Jaclyn B.|last3 = Scanlan|first3 = Mark |title = Use of glycopyrrolate in the treatment of Meniere's disease|journal = The Laryngoscope|volume = 108|issue = 10|pages = 1442–1445|doi = 10.1097/00005537-199810000-00004|s2cid = 39137575}}</ref>

[[Diuretic]]s, 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.<ref>{{Cite journal|last1=Thirlwall|first1=A. S.|last2=Kundu|first2=S.|date=2006-07-19|title=Diuretics for Ménière's disease or syndrome|journal=The Cochrane Database of Systematic Reviews|volume=2010 |issue=3|article-number=CD003599|doi=10.1002/14651858.CD003599.pub2|issn=1469-493X|pmid=16856015|pmc=9007146 }}</ref> 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.<ref>{{Cite journal|last1=Crowson|first1=Matthew G. |last2= Patki |first2= Aniruddha |last3= Tucci| first3=Debara L.|date=May 2016|title=A Systematic Review of Diuretics in the Medical Management of Ménière's Disease|journal=Otolaryngology–Head and Neck Surgery|volume=154|issue=5|pages=824–834|doi=10.1177/0194599816630733|issn=1097-6817|pmid=26932948|s2cid=24741244}}</ref><ref name="pmid31046134">{{cite journal| author=Stern Shavit S, Lalwani AK| title=Are diuretics useful in the treatment of meniere disease? | journal=Laryngoscope | year= 2019 | volume= 129 | issue= 10 | pages= 2206–2207 | pmid=31046134 | doi=10.1002/lary.28040 | doi-access=free }}</ref>

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.<ref name=See2016/><ref name=Pul2011>{{cite journal |last1=Pullens |first1=B |last2=van Benthem |first2=PP |title= Intratympanic gentamicin for Ménière's disease or syndrome. |journal=The Cochrane Database of Systematic Reviews |date=16 March 2011 |issue=3 |article-number=CD008234 |doi= 10.1002/14651858.CD008234.pub2 |pmid=21412917}}</ref><ref name="PMID22699980">{{Cite journal|last1=Huon|first1=Leh-Kiong|last2=Fang|first2=Te-Yung|last3=Wang|first3=Pa-Chun |date= July 2012| title=Outcomes of intratympanic gentamicin injection to treat Ménière's disease|journal=Otology & Neurotology |volume=33|issue=5|pages=706–714 |doi= 10.1097/MAO.0b013e318259b3b1| pmid= 22699980 |s2cid= 32209105}}</ref> This treatment has the risk of worsening hearing loss.<ref name=Pul2011/>

===Diet===
People with MD are often advised to reduce their sodium intake.<ref name="Foster2015rev">{{Cite journal|last=Foster|first=Carol A.|date=2015|title=Optimal management of Ménière's disease|journal=Therapeutics and Clinical Risk Management|volume=11|pages=301–307|doi=10.2147/TCRM.S59023|issn=1176-6336|pmc=4348125|pmid=25750534 |doi-access=free }}</ref><ref name=Esp2016>{{cite book |last1=Espinosa-Sanchez |first1=JM |last2=Lopez-Escamez |first2=JA |chapter=Menière's disease |title=Neuro-Otology |series= [[Handbook of Clinical Neurology]] |date=2016 |volume=137 |pages=257–277 |doi=10.1016/B978-0-444-63437-5.00019-4 |pmid=27638077|isbn=978-0-444-63437-5 }}</ref> Reducing salt intake, however, has not been well studied.<ref name=Esp2016/><!-- Quote = Patients are advised to eliminate the use of salt at the table and limit its use during cooking... These recommendations are based on expert opinions, but evidence is lacking. --> 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.<ref name= Foster2015rev/> There is no high-quality evidence that changing diet by restricting salt, caffeine or alcohol improves symptoms.<ref>{{Cite journal |last1= Hussain |first1= Kiran |last2= Murdin|first2=Louisa|last3=Schilder|first3=Anne GM|date=31 December 2018|title=Restriction of salt, caffeine and alcohol intake for the treatment of Ménière's disease or syndrome |journal=Cochrane Database of Systematic Reviews|volume=2018|issue= 12 |article-number=CD012173|doi=10.1002/14651858.CD012173.pub2|issn=1469-493X|pmid=30596397|pmc=6516805}}</ref>

===Physical therapy===
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.<ref name=See2016/><ref name="PMID9386249">{{Cite journal| last1= Clendaniel |first1= R. A.|last2=Tucci|first2=D. L.|date=December 1997|title=Vestibular rehabilitation strategies in Meniere's disease|journal=Otolaryngologic Clinics of North America| volume= 30 |issue= 6|pages=1145–1158|doi=10.1016/S0030-6665(20)30155-9|issn=0030-6665|pmid=9386249}}</ref>

=== Counseling ===
The psychological distress caused by the vertigo and hearing loss may worsen the condition in some people.<ref>{{Cite journal|last=Orji|first=Ft|date=2014|title=The Influence of Psychological Factors in Meniere's Disease|journal=Annals of Medical and Health Sciences Research|volume=4|issue=1|pages=3–7|doi=10.4103/2141-9248.126601|doi-broken-date=12 July 2025 |issn=2141-9248| pmc= 3952292 |pmid= 24669323 |doi-access=free }}</ref> Counseling may be useful to manage the distress,<ref name=See2016/> as may education and [[relaxation technique]]s.<ref name="Greenberg2010">{{Cite journal|last1=Greenberg|first1=Simon L.|last2=Nedzelski|first2=Julian M.|date=October 2010|title=Medical and noninvasive therapy for Meniere's disease|journal=Otolaryngologic Clinics of North America|volume=43|issue=5|pages=1081–1090|doi=10.1016/j.otc.2010.05.005|issn=1557-8259|pmid=20713246}}</ref>

=== Surgery ===
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.<ref name=See2016/><ref name="Foster2015rev" /><ref name=":0">{{Cite journal |last1=Lee |first1=Ambrose |last2=Webster |first2=Katie E |last3=George |first3=Ben |last4=Harrington-Benton |first4=Natasha A |last5=Judd |first5=Owen |last6=Kaski |first6=Diego |last7=Maarsingh |first7=Otto R |last8=MacKeith |first8=Samuel |last9=Ray |first9=Jaydip |last10=Van Vugt |first10=Vincent A |last11=Burton |first11=Martin J |date=2023-02-24 |editor-last=Cochrane ENT Group |title=Surgical interventions for Ménière's disease |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=2 |article-number=CD015249 |doi=10.1002/14651858.CD015249.pub2 |pmc=9955726 |pmid=36825750}}</ref>

==== Endolymphatic sac surgery ====
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.<ref name="Lim" /> 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.<ref name="Lim">{{Cite journal|display-authors= 3| last1=Lim|first1=Ming Yann|last2=Zhang|first2=Margaret|last3=Yuen|first3=Heng Wai|last4=Leong|first4=Jern-Lin|date=November 2015|title=Current evidence for endolymphatic sac surgery in the treatment of Meniere's disease: a systematic review|journal= [[Singapore Medical Journal]] |volume=56|issue=11|pages=593–598 |doi= 10.11622/smedj.2015166| issn= 0037-5675 |pmc= 4656865 |pmid= 26668402}}</ref> 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.<ref name="Foster2015rev" /> 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).<ref name="PMID24751747">{{Cite journal|last1=Sood|first1=Amit Justin |last2= Lambert |first2= Paul R. |last3=Nguyen|first3=Shaun A.|last4=Meyer|first4=Ted A. |display-authors= 3| date=July 2014|title=Endolymphatic sac surgery for Ménière's disease: a systematic review and meta-analysis |journal= [[Otology & Neurotology]] |volume=35|issue=6|pages=1033–1045|doi=10.1097/MAO.0000000000000324|issn=1537-4505|pmid=24751747|s2cid=31381271}}</ref>

==== Ventilation tubes ====
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,<ref name="Walther2005Rev" /> conclusions about how effective this surgery is and the potential for side effects and harms is not clear.<ref name="Har2014" /><ref name=":0" />

==== Other surgical interventions ====
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.<ref name="Cochrane2013surgery">{{Cite journal|last1=Pullens|first1=Bas|last2=Verschuur|first2=Hendrik P.|last3=van Benthem|first3=Peter Paul|date=2013|title=Surgery for Ménière's disease|journal=The Cochrane Database of Systematic Reviews|volume=2013 |issue=2|article-number=CD005395|doi=10.1002/14651858.CD005395.pub3|issn=1469-493X|pmid=23450562|pmc=7389445}}</ref> The inner ear itself can be surgically removed via labyrinthectomy, although hearing is always completely lost in the affected ear with this operation.<ref name="Cochrane2013surgery" /> The surgeon can also cut the nerve to the balance portion of the inner ear in a [[Vestibular nerve|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.<ref name="Cochrane2013surgery" />

=== Poorly supported ===
* As of 2014, [[betahistine]] is often used as it is inexpensive and safe;<ref name=Har2014/> but evidence does not justify its use in Ménière's disease.<ref name="PMID11279734">{{Cite journal|last1=James|first1=A. L.|last2=Burton|first2=M. J.|date=2001|title=Betahistine for Menière's disease or syndrome|journal=The Cochrane Database of Systematic Reviews |volume=2020 |issue= 1|article-number=CD001873|doi=10.1002/14651858.CD001873|issn=1469-493X|pmid=11279734|pmc=6769057}}</ref><ref name="PMID26797774">{{Cite journal| pmc= 4721211 |year= 2016 |last1= Adrion |first1=C|title=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)|journal=BMJ|volume=352|article-number=h6816|last2=Fischer|first2=C. S.| last3= Wagner |first3= J |last4= Gürkov |first4= R |last5= Mansmann |first5= U|last6=Strupp| first6=M |display-authors= 3| doi=10.1136/bmj.h6816|pmid=26797774}}</ref> However, recent [[pharmacokinetic]] experiments have shown that combination therapy with [[Monoamine oxidase inhibitor]]s can drastically increase the bioavailability of betahistine in humans,<ref name="DOI10.3389/fneur.2023.1271640">Michael Strupp, Grant C. Churchill, Ivonne Naumann, Ulrich Mansmann, Amani Al Tawil, Anastasia Golentsova, Nicolina Goldschagg: ''Examination of betahistine bioavailability in combination with the monoamine oxidase B inhibitor, selegiline, in humans—a non-randomized, single-sequence, two-period titration, open label single-center phase 1 study (PK-BeST).'' In: ''Frontiers in Neurology.'' 2023, Band 14 {{doi|10.3389/fneur.2023.1271640|doi-access=free}}.</ref> and improve cochlear blood flow in [[guinea pigs]].<ref name="DOI10.1177/00034894221098803">Benedikt Kloos, Mattis Bertlich, Jennifer L. Spiegel, Saskia Freytag, Susanne K. Lauer, Martin Canis, Bernhard G. Weiss, Friedrich Ihler: ''Low Dose Betahistine in Combination With Selegiline Increases Cochlear Blood Flow in Guinea Pigs.'' In: ''Annals of Otology Rhinology & Laryngology.'' 2022, Band 132, Nummer 5, S.&nbsp;519–526 {{doi|10.1177/00034894221098803}}.</ref>
* Transtympanic micropressure pulses were investigated in two systematic reviews. Neither found evidence to justify this technique.<ref name="PMID25756795">{{cite journal | pmid = 25756795 | doi=10.1002/14651858.CD008419.pub2 | issue=3 | title=Positive pressure therapy for Ménière's disease or syndrome | year=2015 | journal=Cochrane Database Syst Rev | article-number=CD008419 | author=van Sonsbeek S, Pullens B, van Benthem PP| volume=2015 | pmc=11026870 }}</ref><ref name="PMID25346252">{{Cite journal|last2=Rutka|first2=J. A. |last3= Hendry |first3= J |last4= Browning |first4= G. G.|display-authors= 3| year=2015|title=Positive pressure therapy for Meniere's syndrome/disease with a Meniett device: A systematic review of randomised controlled trials|journal=Clinical Otolaryngology|volume=40|issue=3|pages=197–207|doi=10.1111/coa.12344|pmid=25346252|last1=Syed|first1=M. I.|s2cid=1025535 }}</ref>
* Intratympanic [[steroid]]s were investigated in three systematic reviews. The data were found to be insufficient to decide if this therapy has positive effects.<ref name="PMID19923807">{{Cite journal|last2=Parnes|first2=L. S.|year=2009|title=Intratympanic steroids for inner ear disorders: A review|journal=Audiology and Neurotology |volume= 14 |issue= 6|pages=373–382|doi=10.1159/000241894|pmid=19923807|last1=Hu|first1=A|s2cid=38726308}}</ref><ref name="pmid25215266">{{cite journal|year=2014|title=Intratympanic Therapies for Menière's disease|journal=Current Otorhinolaryngology Reports|volume=2|issue=3|pages=137–143|doi=10.1007/s40136-014-0055-8|pmc=4157672|pmid=25215266|vauthors=Miller MW, Agrawal Y}}</ref><ref>{{Cite journal|last1=Phillips|first1=John S.|last2=Westerberg|first2=Brian|date=2011-07-06|title=Intratympanic steroids for Ménière's disease or syndrome |journal= The Cochrane Database of Systematic Reviews|issue=7|article-number=CD008514|doi=10.1002/14651858.CD008514.pub2|issn=1469-493X|pmid=21735432}}</ref>
* Evidence does not support the use of alternative medicine such as [[acupuncture]] or herbal supplements.<ref name=NIH2016/>

== Prognosis ==
Ménière's disease usually starts confined to one ear; it extends to both ears in about 30% of cases.<ref name=Har2014 /> People may start out with only one symptom, but in Ménière's disease all three appear with time.<ref name=Har2014 /> 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.<ref name=Har2014 />
As of 2020, there has been no recent major breakthrough in the pathogenesis research of Ménière's disease.<ref>{{cite journal |vauthors=Liu Y, Yang J, Duan M |title=Current status on researches of Meniere's disease: a review |journal=Acta Otolaryngol |volume=140 |issue=10 |pages=808–812 |date=October 2020 |pmid=32564698 |doi=10.1080/00016489.2020.1776385 |s2cid=219972013 |doi-access=free }}</ref>

==Epidemiology==
From 3 to 11% of diagnosed dizziness in neuro-otological clinics are due to Ménière's disease.<ref name="Iwasaki">{{Cite journal |last1= Iwasaki| first1= Shinichi |last2= Yamasoba| first2= Tatsuya|date=February 2015|title=Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System|journal=[[Aging and Disease]]|volume=6|issue=1|pages=38–47 |doi= 10.14336/AD.2014.0128|issn=2152-5250|pmc=4306472|pmid=25657851}}</ref> 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.<ref name=Iwasaki/> In around 9% of cases, a relative also had Ménière's disease, indicating a genetic predisposition in some cases.<ref name=See2016/>

The odds of Ménière's disease are greater for people of white ethnicity, with severe obesity, and women.<ref name=Con2015/> Several conditions are often comorbid with Ménière's disease, including [[arthritis]], [[psoriasis]], [[gastroesophageal reflux disease]], [[irritable bowel syndrome]], and [[migraine]].<ref name=Con2015/>

== History ==
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.<ref>{{cite journal | last= Ishiyama |first= G. | display-authors = etal | date = Apr 2015 | title = Meniere's disease: histopathology, cytochemistry, and imaging | journal = Ann N Y Acad Sci | volume = 1343 | issue = 1| pages = 49–57 | doi = 10.1111/nyas.12699 | pmid = 25766597 | bibcode = 2015NYASA1343...49I |s2cid= 36495592 }}</ref><ref>{{cite journal| author-link= Prosper Ménière| first= Prosper |last= Ménière| year=1861| url= http://gallica.bnf.fr/ark:/12148/bpt6k408652b/f242.image |title= Sur une forme de surdité grave dépendant d'une lésion de l'oreille interne| language= fr | publisher= republished online at gallica.bnf.fr| archive-url= https://web.archive.org/web/20160216171229/http://gallica.bnf.fr/ark%3A/12148/bpt6k408652b/f242.image |archive-date=16 February 2016 | trans-title= On a form of severe deafness dependent on a lesion of the inner ear| journal= Bulletin de l'Académie Impériale de Médecine| volume= 26| page= 241}}</ref>

The [[American Academy of Otolaryngology]]{{snd}}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).<ref name=Beasley>{{cite journal |vauthors=Beasley NJ, Jones NS |title=Menière's disease: evolution of a definition |journal=J Laryngol Otol |volume=110 |issue=12 |pages=1107–1113 |date=December 1996 |pmid=9015421 |doi= 10.1017/S002221510013590X|s2cid=37842353 }}</ref>

In 1972, the academy defined criteria for diagnosing MD as:<ref name=Beasley/>
# Fluctuating, progressive, sensorineural deafness
# Episodic, characteristic definitive spells of vertigo lasting 20 minutes to 24 hours with no unconsciousness, vestibular [[pathologic nystagmus|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.<ref name=Beasley/> Finally in 1995, the list was again altered to allow for degrees of the disease:<ref name=Beasley/>
# Certain – Definite disease with [[Histopathology|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.<ref name=Con2015/><ref name=See2016/>

== References ==
{{Reflist}}

==External links==
{{Commons category|Ménière's disease}}
* {{cite journal |display-authors= 3| last1=Basura |first1=Gregory J. |last2=Adams |first2=Meredith E. |last3=Monfared |first3=Ashkan |last4=Schwartz |first4=Seth R. |last5=Antonelli |first5=Patrick J. |last6=Burkard |first6=Robert |last7=Bush |first7=Matthew L. |last8=Bykowski |first8=Julie |last9=Colandrea |first9=Maria |last10=Derebery |first10=Jennifer |last11=Kelly |first11=Elizabeth A. |last12=Kerber |first12=Kevin A. |last13=Koopman |first13=Charles F. |last14=Kuch |first14=Amy Angie |last15=Marcolini |first15=Evie |last16=McKinnon |first16=Brian J. |last17=Ruckenstein |first17=Michael J. |last18=Valenzuela |first18=Carla V. |last19=Vosooney |first19=Alexis |last20=Walsh |first20=Sandra A. |last21=Nnacheta |first21=Lorraine C. |last22=Dhepyasuwan |first22=Nui |last23=Buchanan |first23=Erin M. |title=Clinical Practice Guideline: Ménière's Disease |journal= Otolaryngology–Head and Neck Surgery |date=8 April 2020 |volume=162 |issue=2 suppl |pages=S1–S55 |doi=10.1177/0194599820909438|pmid=32267799 |doi-access=free }}
* [https://med.stanford.edu/ohns/OHNS-healthcare/earinstitute/conditions-and-services/conditions/menieres-disease.html Menière's Disease], Stanford Ear Institute.

{{Medical condition classification and resources
|  DiseasesDB     = 8003
|  ICD10          = {{ICD10|H|81|0|h|80}}
|  ICD9           = {{ICD9|386.0}}
|  ICDO           =
|  OMIM           = 156000
|  MedlinePlus    = 000702
|  eMedicineSubj  = emerg
|  eMedicineTopic = 308
|  MeshID         = D008575 |
Orphanet=45360
}}

{{Hearing and balance}}
{{Authority control}}

{{DEFAULTSORT:Menieres disease}}
[[Category:Diseases of inner ear]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Audiology]]
[[Category:Otorhinolaryngology]]
[[Category:Otology]]