Clinical features

Meniere's disease usually affects one ear but in 30% of cases both ears may be affected eventually (1). The hallmark of the condition is its fluctuating and episodic nature. Typical clinical features of the disease include:

• periodic episodes of rotary vertigo or dizziness.
• fluctuating, progressive, unilateral or bilateral hearing loss.
• tinnitus.
• a sensation of fullness or pressure in one or both ears

Attacks occur intermittently, often in clusters. Clusters may be widely separated, especially in the early stages of the disease. An attack may occur suddenly and can arise daily or as infrequently as once a year (2)

• typical attack starts with cochlear symptoms which is followed by the onset of vertigo. Intensity of vertigo increases rapidly and patients may be forced to lie still. An attack may last from a minimum of 20 min to several hours (but no more than 24 hours).
• prolonged attacks may be seen in some patients together with an increase in volume of tinnitus and temporary hearing loss.
• patient may feel tired and nauseous after an acute attack
• some patients can predict an acute attack while in others a random pattern can be observed
• an attack may be triggered by diet, menstrual cycle or psychosocial stresses

During initial stages of the disease vestibular and cochlear conditions may occur in isolation but with time the symptoms become established (patients complaining of a long standing history of recurrent isolated vertigo without cochlear symptoms are unlikely to be Meniere's patients)

• according to a case series of 243 patients with Meniere’s, only a quarter of cases had vertigo as the initial feature while one third presented with the full triad of vertigo, tinnitus and hearing loss..

Some patients may experience sudden drop attacks, or Tumarkin attacks

• these are thought to be due to a sudden mechanical deformation of the otolithic membrane, resulting in activation of motoneurons in the vestibulospinal pathway
• patients fall down without loss of consciousness which occurs instantaneously and may experience the feeling of being pushed or pulled.

Meniere’s disease usually “burns itself out” after about 5-15 years. Although the episodes of vertigo ceases, the patient may experience a constant mild disequilibrium, tinnitus, and moderate (but not complete) unilateral hearing loss (2)

Reference:

• (1) Harcourt J, Barraclough K, Bronstein AM. Meniere's disease. BMJ. 2014;349:g6544
• (2) Leong S. Clinical Review - Ménière's disease. GPOnline 2011