History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include positive family history, recent viral illness, and autoimmune disorders.
vertigo
Recurrent episodes of vertigo, described as a spinning sensation lasting minutes to hours. Usually associated with nausea and vomiting. Attacks tend to cluster in groups.
hearing loss
Usually fluctuating and worsens during or around the vertigo spells in initial stages.
May become constant in later stages. Usually unilateral in the affected ear.
tinnitus
Usually described as roaring tinnitus. Usually unilateral in the affected ear.
aural fullness
Occurs in the affected ear.
May increase prior to an attack.
uncommon
drop attacks
Sudden loss of balance without loss of consciousness or other autonomic or neurological symptoms.
More common in older people but can occur at any age.
Tend to occur in late stages.
Other diagnostic factors
common
positive Romberg's test
Swaying or falling when asked to stand with feet together and eyes closed.
Fukuda's stepping test
Turning towards the affected side when asked to march in place with eyes closed.
uncommon
bilateral symptoms
Autoimmune inner-ear disease is suspected in patients with bilateral meniere's disease or history of other autoimmune systemic disorders.
nystagmus
Horizontal and/or rotatory nystagmus that can be suppressed by visual fixation.
Seen in acute attacks.
tandem walk
Inability to walk (heel-to-toe) in a straight line.
Risk factors
weak
recent viral infection
Viral infection with haematogenous spread, or direct spread through the round window membrane as a result of middle-ear infection or at the time of an upper respiratory tract infection, has been implicated in meniere's disease (MD).[15]
It is thought that viral infections cause inflammation in the inner ear and subsequently trigger a reactive immune response in the vicinity of the endolymphatic sac, causing damage to its function.
Evidence of viral aetiology is supported by demonstration of the presence of human cytomegalovirus by polymerase chain reaction in the endolymphatic sac tissues; antiviral immunoglobulin E in the sera of patients with MD; elevated anti-herpes simplex virus immunoglobulin G (IgG) in the perilymph of patients with MD; and higher titres of IgG against adenovirus and varicella zoster in patients when compared with controls.[19]
genetic predisposition
There have been several reports in the literature about a genetic predisposition in meniere's disease (MD). Hereditary factors have been found to play a role in 10% to 50% of cases.[15]
The most commonly reported mode of inheritance is autosomal dominant pattern, but X-linked inheritance has also been reported.
Higher frequency of histocompatibility antigen (HLA-DR, -DQ, and -DP) has been reported in patients with MD compared with controls.[15]
autoimmune disease
Patients with associated autoimmune disorders such as vasculitis, rheumatoid arthritis, and lupus may have an autoimmune inner-ear disorder.[20] This is especially likely when meniere's disease is bilateral at initial presentation.
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