Ménière's disease and tinnitus

Abstract

Keypoints: 1. Ménière's disease is a clinical syndrome that comprises vertigo, sensorineural hearing loss, subjective tinnitus, and aural fullness. 2. The tinnitus is classically low pitched and evolves with the progression of the disease. 3. The diagnosis of Ménière's disease is based on patient history, a clinical examination, a complete oto-neurological assessment, and a MRI. 4. The differential diagnosis distinguishes Ménière's disease from vestibular schwannoma, microvascular conflict of the VIII cranial nerve, and migraines. 5. Antivertiginous, antihistamines, loop diuretics, antiemetics, and benzodiazepines are effective in managing the acute attacks. 6. The following therapies are recommended for inter-crises periods: (a) Dietetic recommendations including low-salt diet (b) Medication (antihistaminics, diuretics, osmoregulators, vasodilators, antiemetics, corticoids, benzodiazepines) (c) Relaxation therapy, tinnitus retraining therapy, sound therapy, etc. (d) Coordinated treatment of temporomandibulaires and cervical disorders (e) Intratympanic therapy with gentamycin or steroids (f) Surgical approach by endolymphatic mastoid shunt or endolymphatic sac decompression, vestibular neurotomia, and labyrinthectomia. 7. Some medications as well as transtympanic therapy seem particularly interesting, because they provide improvements of both vertigo and tinnitus while preserving the hearing in the majority of patients who have this treatment. 8. Conservative treatments should be exhausted and surgery reserved for patients with disabling and refractory vertigo, but surgery cannot prevent the progression of the tinnitus. © Springer Science+Business Media, LLC 2011.