Ménière's disease: management in primary care.

Abstract

Meniere’s disease is an idiopathic disorder of the inner ear causing the debilitating vestibular and auditory symptoms of vertigo, hearing loss, tinnitus, and aural fullness; vertigo attacks are the most problematic facet of the disease for sufferers.1 Diagnostic certainty is problematic given the absence of a pathognomonic test, making it a challenging and often incorrectly attributed diagnosis in both primary and secondary care.2 The lifetime prevalence has been measured as 34–190 cases per 100 000, tending to affect adults between the third and seventh decades of life3 with paediatric cases being rare. The effect on patients’ daily living can be significant. Eighty-six per cent of patients found that their job performance suffered as a result of their Meniere’s and 70% had to modify their work in some way to accommodate this.1 While the exact pathophysiology remains unknown, there is believed to be a relationship to endolymphatic hydrops, where the potassium-rich extracellular fluid present within the inner ear is present at higher pressures than normal. This was shown in postmortem examinations of all Meniere’s sufferers.4 However, not all patients with endolymphatic hydrops exhibit signs and symptoms of Meniere’s disease. It has therefore been purported that there may be one or more other co-factors:4 autoimmune, viral, allergic, …