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261: MÉNIÈRE DISEASE

Eric Shamus, PhD, DPT, PT, CSCS; Jennifer Shamus, PhD, DPT, COMT, CSCS

CONDITION/DISORDER SYNONYM

  • Endolymphatic hydrops

ICD-9-CM CODES1

  • 386.0 Ménière disease

  • 386.00 Ménière disease unspecified

  • 386.01 Active Ménière disease cochleovestibular

  • 386.02 Active Ménière disease cochlear

  • 386.03 Active Ménière disease vestibular

  • 386.04 Inactive Ménière disease

ICD-10-CM CODES2

  • H81.01 Ménière disease, right ear

  • H81.02 Ménière disease, left ear

  • H81.03 Ménière disease, bilateral

  • H81.09 Ménière disease, unspecified ear

PREFERRED PRACTICE PATTERNS3

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

FIGURE 261-1

The structure of the ear and its principal diseases. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

“A 38-year-old male clerk saw his doctor because of sudden episodes of nausea and dizziness. These attacks had started 3 weeks earlier and seemed to be getting worse. The abnormal episodes at first lasted only a few minutes, during which “the room seemed to spin.” Lately, they had been lasting for many hours. A severe attack caused the patient to vomit and to hear abnormal sounds (ringing, buzzing, paper-rolling sounds) in the left ear. He thought that he was becoming deaf on that side.

The neurologic examination was within normal limits except for a slight sensorineural hearing loss in the left ear. Computed tomography (CT) examination of the head was unremarkable.”4

KEY FEATURES

Description

  • Chronic disorder of the peripheral vestibular and auditory systems (inner ear).

  • Auditory systems description

    • Complex series of interconnected tubes that are fluid-filled (fluid called endolymph) and form a labyrinth.

    • Peripheral vestibular sensory organs of each ear detect head position and head motion to provide input for gaze stability, orientation, and balance.

    • Peripheral auditory sensory organs of each ear convert sound vibration into a neural impulse to provide input for hearing.

    • Each system sends its respective sensory information, via the vestibulocochlear nerve (cranial nerve VIII), to the central nervous system for processing.

  • The pathophysiology of Ménière disease is not completely understood, however it is theorized that it is due to aberrant fluid homeostasis, which leads to overproduction of endolymph and distention of the membranous labyrinth.

  • Results in reports of severe relapsing and remitting episodes of rotary vertigo (illusion of spinning motion of the room or self) that can occur for minutes to hours.

  • Associated symptoms of fluctuating low-frequency sensory neural hearing loss, ear fullness, and tinnitus (ringing in the ear).

TABLE 261-1Diagnostic Scale for Ménière Disease of the AAO-HNS a
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TABLE 261-1 Diagnostic Scale for Ménière Disease of the AAO-HNS a
Certain Ménière Disease
Definitive Meniere’s ...

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