Fortnightly review: Diagnosis and treatment of Ménière's disease

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7128.368 (Published 31 January 1998)
Cite this as: BMJ 1998;316:368

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  1. Shakeel R Saeed, senior registrar in otolaryngologya
  1. a University Department of Otolaryngology-Head and Neck Surgery Manchester Royal Infirmary Manchester M13 9WL

    Introduction

    In 1861 Prosper Ménière described a syndrome characterised by deafness, tinnitus, and episodic vertigo. Contrary to the thinking at that time, he correctly thought that the condition was a disorder of the inner ear.1 In 1938 the principal underlying pathology, endolymphatic hydrops, was described by Hallpike and Cairns (fig 1),2 but the precise aetiology of Ménière's disease still remains elusive. This fact, coupled with the capricious behaviour of the disease and the clinically important response to placebo treatment, has aroused controversy about its management and has plagued the scientific evaluation of the results of the various treatments used.

    Fig 1

    Histological section of the cochlea showing distension of the scala media (sm) due to endolymphatic hydrops. Note that the basal turn has been spared. Reproduced from Hawke and Jahn3 with permission

    Summary points

    The aetiology of Ménière's disease is multifactorial but the relation between these factors and the development of the disease remains unknown

    Distension of the endolymphatic compartment of the inner ear may be due to otological or systemic disorders and is the constant pathological finding

    This condition can be diagnosed on clinical grounds and simple audiometry. Secondary endolymphatic hydrops and space occupying lesions of the cerebellopontine angle need to be excluded

    The relapsing-remitting nature of the disorder, response to placebo, and undetermined aetiology have plagued scientific attempts to evaluate treatments

    Around three quarters of patients respond to medical treatment or enter a state of prolonged remission. For the rest, surgery aims to control the disabling vertigo

    Bilateral Ménière's disease remains a therapeutic challenge

    Methods

    Over the years, a vast literature has accumulated on Ménière's disease. I have based this article on information gained from three sources.

    The first was a Medline search from 1966 to 1997, which yielded nearly 2000 references using the text word “Ménière's” and 546 citations …

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