Confirming the Disease Name
Menière's disease (메니에르병) — This is the medically accepted name. The main pathophysiology is explained by endolymphatic hydrops.
1) Disease Description (Causes and Symptoms)
- Cause·pathophysiology: An abnormal increase in endolymphatic fluid in the inner ear causes the endolymphatic duct and endolymphatic sac to swell, resulting in impaired function of the cochlea (hearing) and vestibular organs (balance). The exact cause is unknown.
- Main symptoms:
- Recurrent tinnitus, aural fullness, fluctuating hearing loss (usually beginning in the low-frequency range), and recurrent sudden vertigo (severe dizziness)
- Nausea and vomiting may accompany attacks of dizziness, and the duration of attacks varies from several tens of minutes to several hours (rarely more than a day).
- Bilateral cases are reported in approximately 10–20% of cases. Dizziness generally decreases over time, but hearing loss may be progressive.
2) Treatment Methods
- Lifestyle management
- A low-salt diet (limiting salt intake), avoiding caffeine, alcohol, nicotine, excessive sugar intake, and sudden changes in fluid intake, and managing stress and sleep.
- Avoid dangerous activities such as driving or working at heights during an attack of dizziness.
- Medication treatment
- Acute attacks: Symptom relief with antiemetics (such as ondansetron), sedatives/antihistamines (such as meclizine), and benzodiazepines (short-term).
- Basic treatment: An attempt may be made to control endolymphatic pressure with diuretics (thiazides, acetazolamide, etc.); betahistine (used in some countries) — some cases report symptom improvement (evidence varies).
- For chronic management, nasal or systemic steroids may be considered as needed (depending on symptoms and changes in hearing).
- Local treatment/procedures·surgery
- Intratympanic medication administration: Intratympanic steroids (for the purpose of preserving hearing) or gentamicin (to control vertigo through selective destruction of vestibular function; there is a risk of worsening hearing).
- Endolymphatic sac decompression/shunt surgery: Considered when conservative treatment fails.
- Vestibular neurectomy or surgery that destroys vestibular function (surgery resulting in loss of inner-ear function): Selected when the condition is limited to one ear and hearing must be preserved to some extent.
- Rehabilitation and assistive devices
- Vestibular rehabilitation; if hearing loss progresses, hearing aids, assistive listening devices, or implantation (in severe cases) may be considered.
- Precautions
- Ototoxic medications such as intratympanic gentamicin may cause hearing damage and therefore require careful selection.
- The choice of treatment is individualized according to symptom frequency, severity, hearing status, and patient preference.
3) Checkpoints Before an Outpatient Visit (Including Preparation Items and Example Questions)
- Preparation items·materials
- A list of medications currently being taken (including prescription drugs, OTC medications, and herbal medicines)
- Previous hearing tests (audiograms), nystagmus tests, and CT/MRI results (if available)
- Attack diary: attack frequency, duration, triggers (sleep, stress, meals, etc.), accompanying symptoms (vomiting, headache, etc.), and recovery pattern after attacks
- Records of when changes in hearing or tinnitus·aural fullness usually occur
- Materials·records to present at the outpatient visit
- When the most recent attack occurred and the degree of activity limitation during attacks (such as whether driving was possible)
- Family history (ear disease, vertigo, etc.)
- Example questions (items the patient can record independently and bring to the visit)
- When attacks began/their frequency/their duration
- Whether symptoms worsen with specific foods, medications, or environments
4) Examples of General Questions to Ask the Doctor
- "What initial (nonsurgical) treatment do you recommend? How much benefit can be expected?"
- "What are the side effects of the medication I am currently taking?"
- "What is the usual course and prognosis of this disease? How likely is hearing loss to progress?"
- "When are surgery or intratympanic treatment needed, and what are the risks (especially hearing damage)?"
- "Are there any lifestyle changes I must make or precautions I should take in daily life?"
5) Examples of Disease-Specific Questions
- "Could you confirm whether low-frequency hearing loss has been repeatedly observed on my hearing tests (audiograms)? What is the trend compared with my recent tests?"
- "What are the criteria for considering interventional treatments such as intratympanic treatment (intratympanic steroids or gentamicin) or endolymphatic sac surgery, and am I a candidate for surgery?"
Reference (Summary)
- Key symptoms: Recurrent vertigo, fluctuating hearing loss, tinnitus, aural fullness
- Basic approach: Lifestyle measures + medication (diuretics·symptom-relieving medications, etc.) → transition to local injections·surgery if necessary
- Prognosis: Vertigo often naturally decreases over time, but hearing loss may progress
(If necessary, please request additional information so that an individualized treatment plan can be specified based on the latest clinical guidelines and expert opinions.)