Proceedings of UCLA Healthcare

-VOLUME 18 (2014)-

CLINICAL VIGNETTE

Meniere’s Disease: A Common Disorder In Outpatient Clinic

By Brian S. Morris, MD

Case Report

The patient is a 55-year-old male with a history of 1000 patients3. Some European countries have a
asthma and melanoma who presents with a two-year higher incidence of Meniere’s although that may be
history of attacks of vertigo, right ear fullness, right related to greater reporting4. Half of all patients
ear hearing loss, and tinnitus. In 2010, he was treated report a family history of the disorder5. 90% of
with oral steroids by another physician and his patients with Meniere’s disease have a unilateral
symptoms improved. He subsequently had three more presentation and half of such patients will eventually
vertigo attacks with similar symptoms in his right ear. have bilateral involvement6. Meniere’s disease can
The timing of his vertigo coincides with present at any age including the very young and the
exacerbations of his asthma. His symptoms are elderly, but the peak age of presentation is between
aggravated by a high salt diet. He has been receiving the ages of 40-60. Interestingly, Meniere’s tends to
immunotherapy for his allergies and follows a low affect women more often than men and Caucasians
salt diet which he believes reduces the frequency of more often than those of Asian, Hispanic, or African
the attacks. Americans7.

His past medical history includes allergic rhinitis. Etiology and Pathophysiology
Current medications includes inhaled albuterol.
Meniere’s disease is an idiopathic disorder although
some cases are secondary to infections, metabolic
He does not smoke and he rarely drinks alcohol. disorders, trauma, autoimmune disorders, endocrine
Family history is negative for tinnitus and vertigo. disorders, or medications3. Meniere’s can also be
aggravated by allergic disorders such as asthma8.
Although the exact pathophysiology of Meniere’s
His physical examination revealed a blood pressure
of 110/72, pulse 84, normal temperature, weight 219 disease is unknown, patients have increased
pounds, and BMI of 28. No nystagmus was present. endolymphatic pressure from excess lymph
accumulation2. Increases in pressure within the
His neurologic and ear exams were normal except for
endolymph and perilymph chambers, as well as
Rinne and Weber testing consistent with
abnormalities within the membrane that separates
sensorineural hearing loss in the right ear.
them, lead to alterations in pressure resulting in
vertigo, hearing issues, and tinnitus2. Chemical
Laboratory evaluation revealed a normal CBC,
changes ultimately affect nerve receptors and hair
chemistries, ESR, and TSH. Audiology evaluation
cells in the inner ear resulting in acute symptoms2.
confirmed a low frequency hearing loss in the right
ear with normal hearing in the left ear. The apex of the cochlea, rather than the base, appears
to be more sensitive to these changes leading to low
frequency sounds being affected rather than high
The patient had an MRI of the head which was
frequency sounds2.
negative and he was referred to ENT where a
diagnosis of Meniere’s disease was confirmed. Clinical Features

General Discussion and Epidemiology The clinical features of Meniere’s disease include
recurrent episodes of vertigo, ear fullness, hearing
Meniere’s disease, also known as endolymphatic loss, and tinnitus9. Either tinnitus or ear fullness
hydrops, is an idiopathic disorder of the inner ear must be present to make the diagnosis9. Vertigo is the
associated with increased endolymphatic pressure1. most common presenting complaint10. The vertigo
The condition results in tinnitus which is associated may be brief, lasting minutes to hours, or may be
with hearing loss and vertigo2. In The United States, longstanding and be associated with nausea and
Meniere’s disease has an incidence of 1 in every vomiting11. At least two episodes of vertigo of at
 Proceedings of UCLA Healthcare
-VOLUME 18 (2014)-

least 20 minutes in duration are required to make a Prognosis

diagnosis11. About 12% of patients with vertigo have
Meniere’s disease12. Patients are typically fatigued The prognosis of patients with Meniere’s disease is
after an episode, but usually feel well between unpredictable17. Symptoms can be significantly worse
episodes except for a gradual deterioration in hearing early in the course of the disease when pressure
and balance with each episode11. Environmental fluctuations are more noticeable to patients15. The
triggers include dietary, psychosocial, or hormonal frequency of episodes can vary with about 5% of
factors11. Sensorineural hearing loss affects the low patients ultimately requiring surgery18. Most patients
frequency tones and tends to worsen as the disorder improve over time as the disease “burns out”
progresses13. Episodic tinnitus that sounds like a resulting in hearing loss, ataxia, and residual
vibrating whistle or a low frequency roar is another tinnitus15. Drop attacks can occur which can be a
common clinical feature14. cause of morbidity and mortality19.

Diagnosis and Testing Clinical Course and Follow-Up

The physical condition of patients can vary11. Patients The patient made some adjustments in his lifestyle
can look quite ill during attacks with vomiting, reducing salt, caffeine, alcohol, and stress. His
diaphoresis, syncope and nystagmus15. Examination symptoms stabilized and he is now being monitored
with otoscopy is fairly normal and the examination to see if further treatments need to be considered.
itself may elicit symptoms15. A complete neurologic
exam should be performed to rule out other
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Submitted on June 1, 2014