Menière's Disease: The Triad of Vertigo, Hearing Loss, and Tinnitus

Menière's disease is an inner ear disorder characterised by episodic attacks that combine four hallmark features: vertigo (violent rotational spinning lasting 20 minutes to several hours), fluctuating low-frequency sensorineural hearing loss in the affected ear, tinnitus (typically low-pitched roaring or buzzing), and a sense of pressure or fullness in the ear. The attacks are unpredictable and severely disabling — patients live in fear of the next episode, with significant impact on work, driving, and quality of life.

The Underlying Mechanism

The most widely accepted theory is endolymphatic hydrops — excess accumulation of endolymph (the fluid within the inner ear's membranous labyrinth) that causes the membranes to distend and eventually rupture, releasing endolymph into the perilymph compartment and triggering the acute attack. What causes this abnormal fluid accumulation is incompletely understood but likely involves: impaired endolymph reabsorption; immune-mediated inner ear disease; anatomical variations in the endolymphatic duct. Definitive Menière's diagnosis requires pathological confirmation — clinical diagnosis is based on characteristic symptoms.

Diagnosis

Pure tone audiogram: low-frequency (250–1000 Hz) sensorineural hearing loss — this specific pattern of hearing loss is highly characteristic. The hearing loss may partially recover between attacks initially, but progressively becomes permanent over years. Electrocochleography (EcochG): elevated summating potential/action potential ratio. MRI: to exclude acoustic neuroma (which can produce identical symptoms — always image unilateral vestibulo-cochlear symptoms).

Management

Lifestyle: Low-salt diet (below 2 grams sodium per day — the most important intervention); avoid caffeine, alcohol; stress management. Medications: betahistine (most commonly used in India — modest evidence); diuretics (hydrochlorothiazide + triamterene); acute attacks: vestibular suppressants, antiemetics. Intratympanic injections: gentamicin (ablates vestibular function in the affected ear — effective but risks permanent hearing loss) or methylprednisolone (preserves hearing). Surgery: endolymphatic sac decompression or vestibular nerve section for refractory cases. Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.