A 40-year-old woman presents with recurrent episode of vertigo associated with a feeling or ‘fullness’ and ‘pressure’ in her ears. She thinks her hearing is worse during the attacks. Clinical examination is unremarkable. What is the most likely diagnosis?
Meniere’s disease
Benign paroxysmal positional vertigo
Acoustic neuroma
Cholesteatoma
Somatisation
Dr. Kasper:
Meniere’s disease
Meniere’s disease is a disorder of the inner ear of unknown cause. It is characterised by excessive pressure and progressive dilation of the endolymphatic system. It is more common in middle-aged adults but may be seen at any age. Meniere’s disease has a similar prevalence in both men and women.
Features
recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years
Natural history
symptoms resolve in the majority of patients after 5-10 years
the majority of patients will be left with a degree of hearing loss
psychological distress is common
Management
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit