Menière's disease: pathophysiology and treatment.

Menière's disease is defined by the association of 4 symptoms: vertigo attacks, fluctuating hearing loss, tinnitus and an auricular plenitude sensation. The pathophysiology is commonly explained by a distension of membranous labyrinth by the endolymph, equally called endolymphatic hydrops. Recent studies also tend to relate the disease to immune mechanisms. The treatment is medical in the majority of patients but there is no international consensus on the management of the different stages of Menière's disease. Regarding the lack of clinical studies clearly demonstrating the effectiveness of a certain therapy or another. the recommendations are usually based on the empirical experience of practitioners and on the observation of a marked amelioration at 2 years of treatment in the majority of patients. The treatment of the acute phase of Menière's disease is basically symptomatic. Vestibular suppressant drugs have a well-established record in controlling acute attacks of vertigo. Most have variable anticholinergic, anti-emetic and vestibular sedative effects. If necessary, the administration of benzodiazepines will help to alleviate anxiety. Long term management of Menière's disease includes a low salt diet, the use of diuretics in the post-crisis phase, and the very common use in Europe of histaminergic agents. Corticosteroids are used in bilateral forms of Menière's disease, particularly if an autoimmune basis is suspected. All authors insist on the interest and the importance of regular follow-up, especially with regard to the psychological status and responsiveness to treatment of the patient. Surgical indications are rare and the least invasive procedures are used first. The choice of the procedure should take into consideration the need to preserve the auditory function of the patient.