Longer lasting episodic rotational vertigo

Background: Menieres disease is a rare disorder of the inner ear. The exact aetiology is unknown but there is a theory this it is associated with / a result of endolymphatic hydrops (expansion of the endolymphatic compartment within the inner ear.

It is categorised by intermittent episodes of rotational vertigo lasting from 2 – 24 hours associated with unilateral low frequency hearing loss and tinnitus with pressure feeling in the affected ear.  With time the fluctuating hearing loss can become a progressive permanent loss and the episode of rotational vertigo are replaced by a chronic balance upset. 

Patients may be classified as possible, likely or definite Menieirs disease dependant on their symptoms and pure tone audiogram results.

How to manage:

Consider other causes – otitis media with effusion is more common and can give hearing loss, feeling of pressure in the ear

Advice on lifestyle / dietary modifications (Low salt diet and avoidance of caffeine / alcohol)

Prochloperazine for acute exacerbations – this should be given for maximum 3 days at a time

Betahistine

Thiazide diuretic

Referral guidance:

Refer to ENT on a routine basis if diagnostic doubt or for consideration of escalation of therapy beyond thiazide diuretics

Vestibular migraine is a common cause of dizziness. This is far more common than Meniere's disease and many symptoms overlap. In those with a history of migraines or headaches associated with their vertigo episodes, vestibular migraine is the most likely cause of their dizziness and treatment should be commenced as per neurology guidelines. Please see the the Barany Society diagnostic criteria.