Ménière's disease

• Endolymphatic hydrops

• 386.0 Ménière's disease
• 386.00 Ménière’s disease unspecified
• 386.01 Active Ménière's disease cochleovestibular
• 386.02 Active Ménière's disease cochlear
• 386.03 Active Ménière's disease vestibular
• 386.04 Inactive Ménière's disease

• H81.01 Ménière's disease, right ear
• H81.02 Ménière's disease, left ear
• H81.03 Ménière's disease, bilateral
• H81.09 Ménière's disease, unspecified ear

• 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling
• 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

• 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’s 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)

Essentials of Diagnosis

• No definitive objective test for diagnosis is available
• According to the American Academy of Otolaryngology–Head and Neck Surgery criteria, a definitive diagnosis of Ménière’s disease requires
  • Two or more episodes of vertigo of at least 20 minutes in length
  • Audiometrically documented hearing loss on at least one occasion
  • Tinnitus and aural fullness (ear pressure)
• Thorough and detailed history is essential to distinguish Ménière’s disease from other vestibular disorders and central pathology
• Audiogram will fluctuate between normal and abnormal, and with later stages, will demonstrate a fixed loss
• Neurotologic exam may be normal in early stages and when in remission, however in later stages or when experiencing an episode, can be abnormal
• Normal physical exam

General Considerations

• Spontaneous, severe episodes of rotary vertigo that also cause nausea and vomiting and difficulty standing and walking
• Patients also will have hearing loss, ear fullness, and tinnitus and the symptoms can last from 20 minutes to hours
• Intervals between these episodes can range from weeks to years
• In between vertiginous episodes
  • Some patients will recover and not have any symptoms
  • Other patients can continue to have hearing loss, ear fullness, and tinnitus, however the symptoms may not be as severe
  • General feeling of dizziness and imbalance that may worsen with quick head movements
• Frequently occurs only in one ear, however a range of 20% to 50% of patients will develop it ...