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# Ménière disease

Ménière disease is an inner ear disorder with attacks of spinning vertigo, ringing, ear fullness and hearing loss that comes and goes.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cochlea](https://durgical.com/en/anatomy/cochlea/)
- [Vestibule](https://durgical.com/en/anatomy/vestibule/)
- [Semicircular canals](https://durgical.com/en/anatomy/semicircular-canals/)
- [Vestibulocochlear nerve (VIII)](https://durgical.com/en/anatomy/vestibulocochlear-nerve/)
- [Internal acoustic meatus](https://durgical.com/en/anatomy/internal-acoustic-meatus/)
- [Temporal bones](https://durgical.com/en/anatomy/temporal-bone/)

## In histology

- [Vestibular apparatus: maculae, cristae and otoliths](https://durgical.com/en/histology/vestibular-apparatus-maculae-cristae-and-otoliths/)
- [Inner ear: the cochlea and the organ of Corti](https://durgical.com/en/histology/inner-ear-the-cochlea-and-the-organ-of-corti/)

## In the clinical exam

- [Otoscopy and the Rinne and Weber tests](https://durgical.com/en/clinical-exam/otoscopy-and-the-rinne-and-weber-tests/)

## In physiology

- [Vomiting and its control](https://durgical.com/en/physiology/vomiting-and-its-control/)
- [The vestibular system, tone and posture](https://durgical.com/en/physiology/the-vestibular-system-tone-and-posture/)
- [Hearing: middle ear, cochlea and auditory pathway](https://durgical.com/en/physiology/hearing-middle-ear-cochlea-and-auditory-pathway/)

## What it is

Inner ear disorder with recurrent attacks of vertigo, fluctuating sensorineural hearing loss, tinnitus and ear fullness, linked to endolymphatic hydrops (excess endolymph in the membranous labyrinth).

## Who gets it

Usually begins between about 40 and 60 years of age. It is usually one-sided at first; the other ear can become involved over time.

## Causes

- Idiopathic in most cases (Ménière disease)
- Secondary hydrops after trauma, infection or other inner ear disease (Ménière syndrome)
- Genetic and autoimmune factors proposed

## Risk factors

- Family history
- Autoimmune disease
- Migraine (frequent association)
- Allergy (association proposed)

## Pathophysiology

Endolymph is produced or absorbed abnormally, and the membranous labyrinth swells (endolymphatic hydrops). Changes in pressure and possible membrane ruptures disturb hair cell function in the [cochlea](https://durgical.com/en/anatomy/cochlea/) and vestibule, causing attacks. Repeated attacks damage hair cells, leading to permanent, at first low-frequency, hearing loss.

## Classification

- Definite Ménière disease
- Probable Ménière disease (diagnostic criteria vary between societies)

## Symptoms and signs

- Spontaneous attacks of spinning vertigo lasting from about 20 minutes to 12 hours
- Fluctuating hearing loss in the affected ear, low frequencies first
- Tinnitus, often low-pitched and roaring
- Ear fullness or pressure
- Nausea and vomiting during attacks
- Sudden falls without loss of consciousness (Tumarkin drop attacks) in advanced cases

## Red flags

- Vertigo with focal neurological signs (consider stroke)
- Progressive one-sided hearing loss without attacks (consider vestibular schwannoma)
- Sudden severe hearing loss (needs urgent assessment)
- Drop attacks with injury

## Diagnosis

**Clinical**
Clinical diagnosis based on accepted criteria: two or more spontaneous vertigo attacks of typical duration, audiometrically documented low- to mid-frequency sensorineural loss in the affected ear, and fluctuating aural symptoms, not better explained by another disorder.

**Tests**
Pure-tone audiometry is essential. Vestibular tests (caloric, video head impulse test), electrocochleography in selected cases.

**Imaging**
MRI with gadolinium of the [internal acoustic meatus](https://durgical.com/en/anatomy/internal-acoustic-meatus/) and brain to exclude vestibular schwannoma and other lesions; special delayed MRI sequences can show hydrops in some centres.

## Differential diagnosis

- Vestibular migraine
- Vestibular schwannoma
- BPPV
- Vestibular neuritis or labyrinthitis
- Autoimmune inner ear disease
- Otosyphilis

## Goal of treatment

Reduce the frequency and severity of vertigo attacks, preserve hearing where possible and maintain quality of life.

## Treatment

**Lifestyle**
Lifestyle measures often advised: low-salt diet, limiting caffeine and alcohol, regular sleep and stress management; the evidence is limited.

**Acute**
During attacks, vestibular suppressants (antihistamines, benzodiazepines) and antiemetics for a short time.

**Medical**
Long-term medicines such as diuretics or betahistine are used in many countries; evidence of benefit is mixed and practice varies.

**Procedure**
Intratympanic injections: corticosteroids, or gentamicin to ablate vestibular function in disabling vertigo (risk to hearing).

**Surgical**
Surgery for refractory vertigo: endolymphatic sac surgery, vestibular nerve section, or labyrinthectomy when hearing is no longer useful.

**Rehabilitation**
Vestibular rehabilitation between attacks, and hearing aids or cochlear implant for hearing loss.

## Complications

- Permanent sensorineural hearing loss
- Chronic tinnitus
- Involvement of the other ear
- Falls and drop attacks
- Anxiety and depression

## Prognosis

The course is unpredictable, with clusters of attacks and remissions. Vertigo often lessens over the years, but hearing loss tends to progress and become permanent.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the classic tetrad of Ménière disease?

Episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and ear fullness.

## What histopathological change underlies Ménière disease?

Endolymphatic hydrops: distension of the membranous labyrinth by excess endolymph.

## Which frequencies are typically affected first on audiometry?

Low frequencies, in a fluctuating sensorineural pattern.

## Why is MRI done in suspected Ménière disease?

To exclude a vestibular schwannoma or other lesion of the internal acoustic meatus or brain.

## Which intratympanic drug can ablate vestibular function in refractory Ménière disease?

Gentamicin, which is vestibulotoxic; it carries a risk of hearing loss.

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## Related conditions

- [Benign paroxysmal positional vertigo (BPPV)](https://durgical.com/en/conditions/benign-paroxysmal-positional-vertigo/)
- [Vestibular schwannoma (acoustic neuroma)](https://durgical.com/en/conditions/vestibular-schwannoma/)
- [Migraine](https://durgical.com/en/conditions/migraine/)
- [Presbycusis (age-related hearing loss)](https://durgical.com/en/conditions/presbycusis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Meniere Disease](https://www.ncbi.nlm.nih.gov/books/NBK536955/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/meniere-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/meniere-disease/