Ménière's disease.
OBJECTIVE
Ménière's disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The pathologic process involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops. This review describes the pathogenesis and etiology as well as the diagnosis and treatment of Ménière's disease.


RESULTS
Initial management of Ménière's disease can involve a low-salt diet and a diuretic. Treatment with intratympanic injection of gentamicin can be beneficial when vertigo persists despite optimal medical management. Recent studies have shown that gentamicin reduces vestibular function in the treated ear, although complete ablation of this vestibular function is not typically required in order to achieve control of vertigo.


CONCLUSIONS
Vertigo is often the most debilitating symptom associated with Ménière's disease. Many treatment options exist for the management of vertigo. Intratympanic injection of gentamicin (low dose) can be used in patients for whom vertigo has not been controlled by medical measures. Ongoing research is providing a greater understanding of the effects of gentamicin on vestibular function and of the mechanisms through which gentamicin leads to control of vertigo.
Minor
Lloyd B
LB
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0910, USA. lminor@jhmi.edu
Schessel
David A
DA
Carey
John P
JP
D003131:Combined Modality Therapy; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000008:administration & dosage; D004432:Ear, Middle / Q000187:drug effects; D004584:Electronystagmography / Q000187:drug effects; D018159:Endolymphatic Hydrops / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007267:Injections; D008575:Meniere Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014724:Vestibular Function Tests; D014725:Vestibular Nerve / Q000187:drug effects
D004232:Diuretics; D005839:Gentamicins