PassFinals
ENT

Meniere's Disease

Ménière's disease is a disorder of the inner ear causing recurrent spontaneous vertigo attacks lasting minutes to hours, with fluctuating hearing loss, tinnitus and aural pressure; diagnosis is specialist and other vestibular, neurological and retrocochlear causes must be considered.

In a nutshell

Ménière's disease causes recurrent spontaneous vertigo attacks lasting minutes to hours, with fluctuating hearing loss, tinnitus and aural pressure. Diagnosis is specialist and supported by audiometry; use MRI for asymmetric/localising hearing loss when the NICE pathway indicates. Acute attacks need short-course antiemetic/vestibular-suppressant treatment, while prevention and functional support are ENT/audiovestibular-led. Do not use betahistine for isolated tinnitus, and follow DVLA rules for sudden or recurrent dizziness.

Classic presentation

A person with recurrent spontaneous hours-long spinning attacks, nausea, fluctuating unilateral hearing loss, tinnitus and aural fullness, with no middle-ear explanation.

Key points

  • The pattern is recurrent spontaneous vertigo with fluctuating hearing loss, tinnitus and aural pressure; NHS describes attacks lasting minutes to 24 hours.
  • Audiometry documents sensorineural hearing loss and asymmetry; specialist assessment is needed rather than self-diagnosis.
  • Offer/consider MRI of the internal auditory meati using NICE NG98 criteria for localising signs or significant audiometric asymmetry.
  • Treat attacks briefly with an antiemetic/vestibular suppressant; manage hearing, tinnitus, imbalance and falls risk between attacks.
  • Betahistine may be used for Ménière's disease under current prescribing guidance but is not recommended for tinnitus alone.
  • Sudden neurological symptoms, sudden hearing loss or continuous severe vertigo require urgent alternative pathways.

First-line investigation

Detailed attack history and examination with formal audiometry; arrange specialist audiovestibular assessment and MRI when asymmetry or localising signs meet the NICE pathway.

Management

Exclude stroke and sudden hearing loss

  • Use emergency stroke pathways for focal neurological symptoms and urgent hearing/ENT pathways for sudden hearing loss or acute uncontrolled vestibular symptoms.1,3,4

Control the acute attack

  • Use a short-course prescribed antiemetic or vestibular suppressant, follow BNF advice and prevent falls; avoid driving and hazardous activity while symptomatic.1,7,8

Confirm the pattern and plan prevention

  • Arrange specialist review and serial audiometry where needed; discuss betahistine and personalised lifestyle measures, while explaining that betahistine should not be used for tinnitus alone.1,5,4,8

Preserve hearing, balance and wellbeing

  • Offer hearing aids when communication is affected, tinnitus support and vestibular rehabilitation for persistent imbalance; address distress, sleep, falls risk and work impact.1,3,4

Refer refractory disease to specialists

  • Discuss intratympanic or surgical options only through an ENT/audiovestibular team after weighing hearing, balance and irreversibility; micropressure therapy requires the special governance arrangements in NICE HTG285.1,6

Give driving and safety advice

  • Do not drive during attacks; report sudden, disabling or recurrent dizziness to DVLA and review ongoing hearing, tinnitus, falls and mental-health impact.9,1,4

Exam traps

  • Seconds-long positional vertigo suggests BPPV; continuous days-long vertigo suggests vestibular neuritis/labyrinthitis or another cause, not classic Ménière's.
  • Do not call all recurrent dizziness Ménière's disease without audiometry and exclusion of mimics.
  • Progressive/asymmetric sensorineural hearing loss needs the NICE MRI pathway, not reassurance alone.
  • Betahistine is not a treatment for isolated tinnitus according to NICE NG155.
  • Do not drive during vertigo and tell DVLA if dizziness is sudden, disabling or recurrent.

Illustrations

Low-frequency hearing loss in Ménière diseasePaired pure-tone audiograms showing marked low-frequency sensorineural hearing loss with relative preservation of higher frequencies in the affected ear.Ijustam, Wikimedia Commons · Public domain

Key sources

  1. NHS, Ménière's disease (NHS Ménière's disease)Updated 25 Apr 2023
  2. NHS, Vertigo (NHS vertigo)Updated 2 May 2023
  3. NICE NG98, Hearing loss in adults: assessment and management (NG98)Updated 21 Jun 2018
  4. NICE NG155, Tinnitus: assessment and management (NG155)Updated 11 Mar 2020
  5. NHS, About betahistine (NHS betahistine)Updated 24 Aug 2022
  6. NICE HTG285, Micropressure therapy for refractory Ménière's disease (HTG285)Updated 26 Apr 2012
  7. NHS, About prochlorperazine (NHS prochlorperazine)Updated 7 Sept 2023
  8. British National Formulary, online prescribing information (BNF)
  9. GOV.UK, Dizziness or vertigo and driving (DVLA dizziness and vertigo)Updated 5 Jan 2026

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.