Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Meniere disease

Howard S Moskowitz, MD, PhD
Elizabeth A Dinces, MD
Section Editor
Daniel G Deschler, MD, FACS
Deputy Editor
Daniel J Sullivan, MD, MPH


Meniere disease is a condition that is thought to arise from abnormal fluid and ion homeostasis in the inner ear. The disease is named for Prosper Menière, a French physician who first reported that the inner ear could be the source of a syndrome manifesting episodic vertigo, tinnitus, and hearing loss [1].

The classic pathologic lesion of Meniere disease is termed endolymphatic hydrops. This lesion can be definitively diagnosed only by postmortem histopathologic analysis of the temporal bone. However, hydrops has also been identified in postmortem examination of temporal bones where there was no history of Meniere symptoms.

Meniere disease refers to presentation of the typical set of symptoms with an idiopathic etiology. The symptomatic triad may also occur secondary to other inner ear disorders, in which case it is termed Meniere syndrome. The symptom triad may be a final common pathway of many different inner ear insults.

This topic will present an overview of the diagnosis and treatment of Meniere disease. More detailed topics addressing the differential diagnosis of vertigo, tinnitus, and hearing loss are presented separately. (See "Evaluation of the patient with vertigo" and "Pathophysiology, etiology, and differential diagnosis of vertigo" and "Etiology of hearing loss in adults" and "Sudden sensorineural hearing loss" and "Etiology and diagnosis of tinnitus".)


Meniere disease can begin at any age, but patients typically present with symptoms between the ages of 20 and 40. Meniere syndrome in children is most often associated with congenital malformations of the inner ear [2,3].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 22, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Meniere P. Congestions cerebrales apoplectiformes. Gaz md Paris 1861; 16:55.
  2. Meyerhoff WL, Paparella MM, Shea D. Ménière's disease in children. Laryngoscope 1978; 88:1504.
  3. Jackler RK, Luxford WM, Brackmann DE, Monsell EM. Endolymphatic sac surgery in congenital malformations of the inner ear. Laryngoscope 1988; 98:698.
  4. Schessel DA, Minor LB, Nedzelski J. Meniere's disease and other peripheral vestibular disorders. In: Otolaryngology Head and Neck Surgery, Cummings CW (Ed), Mosby, St. Louis 1998. p.2672.
  5. Balkany TJ, Sires B, Arenberg IK. Bilateral aspects of Meniere's disease: an underestimated clinical entity. Otolaryngol Clin North Am 1980; 13:603.
  6. Enander A, Stahle J. Hearing in Menière's disease. A study of pure-tone audiograms in 334 patients. Acta Otolaryngol 1967; 64:543.
  7. Mizukoshi K, Ino H, Ishikawa K, et al. Epidemiological survey of definite cases of Meniere's disease collected by the seventeen members of the Meniere's Disease Research Committee of Japan in 1975--1976. Adv Otorhinolaryngol 1979; 25:106.
  8. Coelho DH, Lalwani AK. Medical management of Ménière's disease. Laryngoscope 2008; 118:1099.
  9. Kimura RS. Experimental blockage of the endolymphatic duct and sac and its effect on the inner ear of the guinea pig. A study on endolymphatic hydrops. Ann Otol Rhinol Laryngol 1967; 76:664.
  10. Hornibrook J, Bird P. A New Theory for Ménière's Disease. Otolaryngol Head Neck Surg 2017; 156:350.
  11. Yamamoto E, Mizukami C. Development of the vestibular aqueduct in Menière's disease. Acta Otolaryngol Suppl 1993; 504:46.
  12. Alleman AM, Dornhoffer JL, Arenberg IK, Walker PD. Demonstration of autoantibodies to the endolymphatic sac in Meniere's disease. Laryngoscope 1997; 107:211.
  13. Evans KL, Baldwin DL, Bainbridge D, Morrison AW. Immune status in patients with Menière's disease. Arch Otorhinolaryngol 1988; 245:287.
  14. Brookes GB. Circulating immune complexes in Meniere's disease. Arch Otolaryngol Head Neck Surg 1986; 112:536.
  15. Morrison AW. Anticipation in Menière's disease. J Laryngol Otol 1995; 109:499.
  16. Klockars T, Kentala E. Inheritance of Meniere's disease in the Finnish population. Arch Otolaryngol Head Neck Surg 2007; 133:73.
  17. Calenoff E, Zhao JC, Derlacki EL, et al. Patients with Meniére's disease possess IgE reacting with herpes family viruses. Arch Otolaryngol Head Neck Surg 1995; 121:861.
  18. Welling DB, Daniels RL, Brainard J, et al. Detection of viral DNA in endolymphatic sac tissue from Menière's disease patients. Am J Otol 1994; 15:639.
  19. Parker W. Menière's disease. Etiologic considerations. Arch Otolaryngol Head Neck Surg 1995; 121:377.
  20. Radtke A, Lempert T, Gresty MA, et al. Migraine and Ménière's disease: is there a link? Neurology 2002; 59:1700.
  21. LAWRENCE M, MCCABE BF. Inner-ear mechanics and deafness. Special consideration of Meniere's syndrome. J Am Med Assoc 1959; 171:1927.
  22. SCHUKNECHT H. MENIERE'S DISEASE. J Otolaryngol Soc Aust 1963; 1:222.
  23. Duvall AJ 3rd, Santi PA, Hukee MJ. Cochlear fluid balance. A clinical/research overview. Ann Otol Rhinol Laryngol 1980; 89:335.
  24. Brown DH, McClure JA, Downar-Zapolski Z. The membrane rupture theory of Menière's disease--is it valid? Laryngoscope 1988; 98:599.
  25. Saeed SR. Fortnightly review. Diagnosis and treatment of Ménière's disease. BMJ 1998; 316:368.
  26. Hoa M, Friedman RA, Fisher LM, Derebery MJ. Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease. Laryngoscope 2015; 125 Suppl 12:S1.
  27. Perez-Garrigues H, Lopez-Escamez JA, Perez P, et al. Time course of episodes of definitive vertigo in Meniere's disease. Arch Otolaryngol Head Neck Surg 2008; 134:1149.
  28. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113:181.
  29. Harcourt J, Barraclough K, Bronstein AM. Meniere's disease. BMJ 2014; 349:g6544.
  30. Gottschlich S, Billings PB, Keithley EM, et al. Assessment of serum antibodies in patients with rapidly progressive sensorineural hearing loss and Menière's disease. Laryngoscope 1995; 105:1347.
  31. Bloch DB, San Martin JE, Rauch SD, et al. Serum antibodies to heat shock protein 70 in sensorineural hearing loss. Arch Otolaryngol Head Neck Surg 1995; 121:1167.
  32. Shin SO, Billings PB, Keithley EM, Harris JP. Comparison of anti-heat shock protein 70 (anti-hsp70) and anti-68-kDa inner ear protein in the sera of patients with Meniere's disease. Laryngoscope 1997; 107:222.
  33. Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol 2000; 120:615.
  34. Yen PT, Lin CC, Huang TS. A preliminary report on the correlation of vestibular Meniére's disease with electrocochleography and glycerol test. Acta Otolaryngol Suppl 1995; 520 Pt 2:241.
  35. Conlon BJ, Gibson WP. Electrocochleography in the diagnosis of Meniere's disease. Acta Otolaryngol 2000; 120:480.
  36. Rauch SD, Zhou G, Kujawa SG, et al. Vestibular evoked myogenic potentials show altered tuning in patients with Ménière's disease. Otol Neurotol 2004; 25:333.
  37. Lin MY, Timmer FC, Oriel BS, et al. Vestibular evoked myogenic potentials (VEMP) can detect asymptomatic saccular hydrops. Laryngoscope 2006; 116:987.
  38. Taylor RL, Wijewardene AA, Gibson WP, et al. The vestibular evoked-potential profile of Ménière's disease. Clin Neurophysiol 2011; 122:1256.
  39. Boyev KP. Meniere's disease or migraine? The clinical significance of fluctuating hearing loss with vertigo. Arch Otolaryngol Head Neck Surg 2005; 131:457.
  40. Wladislavosky-Waserman P, Facer GW, Mokri B, Kurland LT. Meniere's disease: a 30-year epidemiologic and clinical study in Rochester, Mn, 1951-1980. Laryngoscope 1984; 94:1098.
  41. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl 1:9.
  42. Thorp MA, Shehab ZP, Bance ML, Rutka JA. Does evidence-based medicine exist in the treatment of Menière's disease? A critical review of the last decade of publications. Clin Otolaryngol Allied Sci 2000; 25:456.
  43. Santos PM, Hall RA, Snyder JM, et al. Diuretic and diet effect on Menière's disease evaluated by the 1985 Committee on Hearing and Equilibrium guidelines. Otolaryngol Head Neck Surg 1993; 109:680.
  44. Boles R, Rice DH, Hybels R, Work WP. Conservative management of Méniére's disease: Furstenberg regimen revisited. Ann Otol Rhinol Laryngol 1975; 84:513.
  45. Kinney SE, Sandridge SA, Newman CW. Long-term effects of Ménière's disease on hearing and quality of life. Am J Otol 1997; 18:67.
  46. Claes J, Van de Heyning PH. A review of medical treatment for Ménière's disease. Acta Otolaryngol Suppl 2000; 544:34.
  47. Martinez DM. The effect of Serc (betahistine hydrochloride) on the circulation of the inner ear in experimental animals. Acta Otolaryngol Suppl 1972; 305:29.
  48. Timmerman H. Pharmacotherapy of vertigo: any news to be expected? Acta Otolaryngol Suppl 1994; 513:28.
  49. Thirlwall AS, Kundu S. Diuretics for Ménière's disease or syndrome. Cochrane Database Syst Rev 2006; :CD003599.
  50. James AL, Burton MJ. Betahistine for Menière's disease or syndrome. Cochrane Database Syst Rev 2001; :CD001873.
  51. Adrion C, Fischer CS, Wagner J, et al. Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ 2016; 352:h6816.
  52. Cope D, Bova R. Steroids in otolaryngology. Laryngoscope 2008; 118:1556.
  53. Kilpatrick JK, Sismanis A, Spencer RF, Wise CM. Low-dose oral methotrexate management of patients with bilateral Ménière's disease. Ear Nose Throat J 2000; 79:82.
  54. Rahman MU, Poe DS, Choi HK. Etanercept therapy for immune-mediated cochleovestibular disorders: preliminary results in a pilot study. Otol Neurotol 2001; 22:619.
  55. Gottshall KR, Hoffer ME, Moore RJ, Balough BJ. The role of vestibular rehabilitation in the treatment of Meniere's disease. Otolaryngol Head Neck Surg 2005; 133:326.
  56. Nedzelski JM, Schessel DA, Bryce GE, Pfleiderer AG. Chemical labyrinthectomy: local application of gentamicin for the treatment of unilateral Menière's disease. Am J Otol 1992; 13:18.
  57. Quaranta A, Aloisi A, De Benedittis G, Scaringi A. Intratympanic therapy for Ménière's disease. High-concentration gentamicin with round-window protection. Ann N Y Acad Sci 1999; 884:410.
  58. Perez N, Martín E, García-Tapia R. Intratympanic gentamicin for intractable Meniere's disease. Laryngoscope 2003; 113:456.
  59. Boleas-Aguirre MS, Sánchez-Ferrandiz N, Guillén-Grima F, Perez N. Long-term disability of class A patients with Ménière's disease after treatment with intratympanic gentamicin. Laryngoscope 2007; 117:1474.
  60. Rah YC, Han JJ, Park J, et al. Management of intractable Ménière's disease after intratympanic injection of gentamicin. Laryngoscope 2015; 125:972.
  61. Pullens B, van Benthem PP. Intratympanic gentamicin for Ménière's disease or syndrome. Cochrane Database Syst Rev 2011; :CD008234.
  62. Blakley BW. Update on intratympanic gentamicin for Meniere's disease. Laryngoscope 2000; 110:236.
  63. Harner SG, Driscoll CL, Facer GW, et al. Long-term follow-up of transtympanic gentamicin for Ménière's syndrome. Otol Neurotol 2001; 22:210.
  64. Casani AP, Piaggi P, Cerchiai N, et al. Intratympanic treatment of intractable unilateral Meniere disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngol Head Neck Surg 2012; 146:430.
  65. Chia SH, Gamst AC, Anderson JP, Harris JP. Intratympanic gentamicin therapy for Ménière's disease: a meta-analysis. Otol Neurotol 2004; 25:544.
  66. Cohen-Kerem R, Kisilevsky V, Einarson TR, et al. Intratympanic gentamicin for Menière's disease: a meta-analysis. Laryngoscope 2004; 114:2085.
  67. Gacek RR, Gacek MR. Comparison of labyrinthectomy and vestibular neurectomy in the control of vertigo. Laryngoscope 1996; 106:225.
  68. Kim HH, Wiet RJ, Battista RA. Trends in the diagnosis and the management of Meniere's disease: results of a survey. Otolaryngol Head Neck Surg 2005; 132:722.
  69. Friberg U, Jansson B, Rask-Andersen H, Bagger-Sjöbäck D. Variations in surgical anatomy of the endolymphatic sac. Arch Otolaryngol Head Neck Surg 1988; 114:389.
  70. Moffat DA. Endolymphatic sac surgery: analysis of 100 operations. Clin Otolaryngol Allied Sci 1994; 19:261.
  71. Telischi FF, Luxford WM. Long-term efficacy of endolymphatic sac surgery for vertigo in Menière's disease. Otolaryngol Head Neck Surg 1993; 109:83.
  72. Brinson GM, Chen DA, Arriaga MA. Endolymphatic mastoid shunt versus endolymphatic sac decompression for Ménière's disease. Otolaryngol Head Neck Surg 2007; 136:415.
  73. Kitahara T, Kubo T, Okumura S, Kitahara M. Effects of endolymphatic sac drainage with steroids for intractable Meniere's disease: a long-term follow-up and randomized controlled study. Laryngoscope 2008; 118:854.
  74. Wetmore SJ. Endolymphatic sac surgery for Ménière's disease: long-term results after primary and revision surgery. Arch Otolaryngol Head Neck Surg 2008; 134:1144.
  75. Ostrowski VB, Kartush JM. Endolymphatic sac-vein decompression for intractable Meniere's disease: long term treatment results. Otolaryngol Head Neck Surg 2003; 128:550.
  76. Thomsen J, Bretlau P, Tos M, Johnsen NJ. Placebo effect in surgery for Ménière's disease. A double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol 1981; 107:271.
  77. Welling DB, Nagaraja HN. Endolymphatic mastoid shunt: a reevaluation of efficacy. Otolaryngol Head Neck Surg 2000; 122:340.
  78. Martin-Sanz E, Esteban-Sanchez J, Rodrigañez-Riesco L, Sanz-Fernández R. Transitory effect on endolymphatic hydrops of the intratympanic steroids for Ménière's disease. Laryngoscope 2015; 125:1183.
  79. Garduño-Anaya MA, Couthino De Toledo H, Hinojosa-González R, et al. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngol Head Neck Surg 2005; 133:285.
  80. Barrs DM, Keyser JS, Stallworth C, McElveen JT Jr. Intratympanic steroid injections for intractable Ménière's disease. Laryngoscope 2001; 111:2100.
  81. Boleas-Aguirre MS, Lin FR, Della Santina CC, et al. Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease. Otol Neurotol 2008; 29:33.
  82. Thomsen J, Sass K, Odkvist L, Arlinger S. Local overpressure treatment reduces vestibular symptoms in patients with Meniere's disease: a clinical, randomized, multicenter, double-blind, placebo-controlled study. Otol Neurotol 2005; 26:68.
  83. Gates GA, Green JD Jr, Tucci DL, Telian SA. The effects of transtympanic micropressure treatment in people with unilateral Meniere's disease. Arch Otolaryngol Head Neck Surg 2004; 130:718.
  84. Odkvist LM, Arlinger S, Billermark E, et al. Effects of middle ear pressure changes on clinical symptoms in patients with Ménière's disease--a clinical multicentre placebo-controlled study. Acta Otolaryngol Suppl 2000; 543:99.
  85. Gates GA, Verrall A, Green JD Jr, et al. Meniett clinical trial: long-term follow-up. Arch Otolaryngol Head Neck Surg 2006; 132:1311.
  86. Densert B, Sass K. Control of symptoms in patients with Meniere's disease using middle ear pressure applications: two years follow-up. Acta Otolaryngol 2001; 121:616.
  87. Ahsan SF, Standring R, Wang Y. Systematic review and meta-analysis of Meniett therapy for Meniere's disease. Laryngoscope 2015; 125:203.
  88. van Sonsbeek S, Pullens B, van Benthem PP. Positive pressure therapy for Ménière's disease or syndrome. Cochrane Database Syst Rev 2015; :CD008419.