title: Meniere's disease.
abstract: Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.
authors.affiliation: Department of Rehabilitation, Ichinomiya Medical Treatment &Habilitation Center, 1679-2, Tomida-nagaresuji, Ichinomiya City, 494-0018, Japan.|Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Ilmari
authors.initials: I
authors.lastname: Pyykkö
authors.affiliation: Department of Psychology, School of Health, BPP University, London, UK.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Arroll
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Margaretha L
authors.initials: ML
authors.lastname: Casselbrant
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Foster
authors.affiliation: Ear, Nose and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
authors.forename: Nauman F
authors.initials: NF
authors.lastname: Manzoor
authors.affiliation: Ear, Nose and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Ho
authors.initials: YH
authors.lastname: Young
mesh_terms: D000932:Antiemetics / Q000494:pharmacology / Q000627:therapeutic use; D001299:Audiometry / Q000379:methods; D001569:Benzodiazepines / Q000494:pharmacology / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods; D004111:Dimenhydrinate / Q000494:pharmacology / Q000627:therapeutic use; D007758:Ear, Inner / Q000473:pathology / Q000503:physiopathology; D004710:Endolymph / Q000378:metabolism; D017950:Ganglia, Sensory / Q000002:abnormalities / Q000293:injuries; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008468:Meclizine / Q000494:pharmacology / Q000627:therapeutic use; D008575:Meniere Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D011398:Promethazine / Q000494:pharmacology / Q000627:therapeutic use; D011788:Quality of Life / Q000523:psychology; D014012:Tinnitus / Q000209:etiology; D014717:Vertigo / Q000209:etiology
chemical_list: D000932:Antiemetics; D001569:Benzodiazepines; D008468:Meclizine; D011398:Promethazine; D004111:Dimenhydrinate