sindrome menier

Clinical Presentation: Meniere's syndrome typically presents in adults from age 18 onwards with recurrent episodes of vertigo lasting up to 24 hours, accompanied by fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Vertigo attacks are sudden and disabling, often associated with nausea and vomiting. Hearing loss is usually unilateral initially but may progress. Patients may also experience tinnitus and a sensation of ear fullness during or between attacks ¹; (Nakashima et al., 2016).

Diagnosis: Diagnosis is clinical, based on characteristic symptoms and exclusion of other vestibular disorders. The diagnostic criteria require episodes of vertigo, documented hearing loss on audiometry, tinnitus or aural fullness, and that symptoms are not better explained by another vestibular diagnosis ¹. Audiological assessment including pure tone audiometry is essential to confirm sensorineural hearing loss and to monitor progression ¹; (Zhang et al., 2022). MRI of the internal auditory meati is recommended to exclude vestibular schwannoma or other cerebellopontine angle lesions, especially if asymmetrical hearing loss or neurological signs are present ¹; ². Differential diagnoses such as vestibular migraine, vestibular neuritis, and other causes of vertigo should be considered and excluded ¹.

Management: Management is multidisciplinary and symptom-focused. Acute vertigo attacks are treated with short courses (up to 7 days) of vestibular suppressants such as prochlorperazine or antihistamines (cinnarizine, cyclizine, promethazine teoclate) to relieve nausea, vomiting, and vertigo. These should be used cautiously and only short-term to avoid interference with vestibular compensation ¹. In severe cases, hospital admission for intravenous labyrinthine sedatives and hydration may be necessary ¹.

Betahistine, a weak histamine H1 agonist and H3 antagonist, is commonly prescribed to reduce the frequency and severity of vertigo attacks during the intercritical phase, although evidence for its efficacy is limited and conflicting. Some studies suggest benefit in reducing vertigo symptoms, but high-quality trials show no clear long-term reduction in attack frequency or hearing loss progression ¹; (Adrion et al., 2016); (Casani et al., 2018). If betahistine is ineffective, referral to ENT specialists is advised for consideration of other interventions such as vestibular rehabilitation, diuretics, intratympanic gentamicin or corticosteroids, pressure devices, or surgical options including endolymphatic sac decompression or vestibular nerve section ¹.

Patients should be advised about safety during attacks, including avoiding driving or operating machinery, and informed about the chronic nature of the condition with generally improving vertigo over time ¹. Multidisciplinary support including physiotherapy, audiology, hearing therapy, and psychological support is beneficial ¹.