Ménière’s disease
Overview
Ménière’s disease is a clinical disorder of the inner ear characterised by episodic spontaneous vertigo, fluctuating low‑frequency sensorineural hearing loss and tinnitus, commonly with aural fullness.
It most often presents in middle‑aged adults (typically 30-60 years) and is usually unilateral at onset; bilateral involvement can develop over years. The presumed pathophysiology is endolymphatic hydrops (increased endolymphatic pressure/dilation of the membranous labyrinth), but the precise cause remains uncertain.
Typical presentation
- Recurrent spontaneous vertigo attacks lasting minutes to hours (diagnostic criterion: ≥2 episodes, each ≥20 minutes).
- Attacks may cluster over days or weeks.
- Fluctuating unilateral tinnitus and/or aural fullness, often accompanying vertigo.
- Fluctuating low‑frequency sensorineural hearing loss (best confirmed by formal audiometry).
- Nausea, vomiting and marked disability during attacks.
- Peripheral vestibular nystagmus is common on examination during attacks.
Diagnostic approach in the ED
- Diagnosis is clinical; arrange confirmatory pure‑tone audiometry and ENT review as outpatient follow‑up unless local services permit in‑ED testing.
- Use the ED visit to exclude immediate red flags and to stabilise and treat symptoms.
- Document key historical and examination features that will support outpatient confirmation of the diagnosis.