About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Triad: episodic vertigo (20 min–12 h) + fluctuating low-frequency SNHL + tinnitus + aural fullness
- Caused by endolymphatic hydrops
- Diagnosis: ≥2 vertigo episodes with audiometrically documented SNHL in affected ear
- Acute: prochlorperazine (short course only). Prophylaxis: betahistine 16 mg TDS + low-salt diet
- Refractory: intratympanic gentamicin or endolymphatic sac decompression
- MRI IAM to exclude vestibular schwannoma
Overview
Ménière's disease is characterised by episodic vertigo, fluctuating SNHL (initially low-frequency), tinnitus, and aural fullness. Underlying pathology is endolymphatic hydrops. Typically unilateral at onset; bilateral in 25–40% over time.
Epidemiology
Affects 50–200 per 100,000 adults. Peak 40–60 years. Almost exclusively adults (<3% children). Significant QoL impact.
Clinical Features
Symptoms
Episodic rotational vertigo 20 min–12 h — spontaneous, NOT positional
Fluctuating hearing loss — initially low-frequency
Low-pitched roaring tinnitus
Aural fullness
Drop attacks (Tumarkin crisis) — sudden falls, late disease
Signs
During attack: horizontal nystagmus away from affected ear
Between attacks: examination may be normal
Rinne positive, Weber away from affected ear
Investigations
First-line
Pure tone audiometryLow-to-mid frequency SNHL — required for definite diagnosis
Second-line
MRI IAMExclude vestibular schwannoma
Specialist
ElectrocochleographyElevated SP/AP ratio supports hydrops — not routine
Caloric testingCanal paresis on affected side
1
Acute attack
- Prochlorperazine 5–10 mg or cyclizine 50 mg — short course only
- Anti-emetics if vomiting
2
Prophylaxis
- Betahistine 16 mg TDS
- Low-salt diet <1.5 g/day
- Avoid caffeine, alcohol, nicotine
3
Vestibular rehabilitation
- Physiotherapy for inter-attack imbalance
4
Refractory
- Intratympanic gentamicin (chemical labyrinthectomy)
- Intratympanic dexamethasone
- Endolymphatic sac decompression
- Labyrinthectomy (last resort, destroys hearing)
Complications
- Permanent hearing loss: Progressive, eventually all frequencies, bilateral in 25–40%
- Chronic imbalance
- Tumarkin crisis: Drop attacks without LOC
- Psychosocial impact
UKMLA Exam Tips
- 1Ménière's: vertigo 20 min–12 h + SNHL + tinnitus + fullness — all SAME ear
- 2BPPV = seconds, positional, NO hearing loss. Ménière's = minutes-hours, spontaneous, WITH hearing loss
- 3Betahistine 16 mg TDS — standard UK prophylaxis
- 4Low-frequency SNHL on audiogram = early Ménière's (vs high-frequency = presbyacusis)
- 5Unilateral SNHL + vertigo → exclude vestibular schwannoma → MRI IAM
- 6Tumarkin crisis: sudden drops without LOC — late-stage
practicetest your knowledge on Ménière's DiseaseApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — ENT and beyond.
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