Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression.

Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study.

Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21–88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9–63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire – Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively.

The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.

To identify and evaluate cranial magnetic resonance imaging findings associated with Ménière's disease.

Seventy-eight patients with a documented diagnosis of Ménière's disease and 35 controls underwent 1.5 T or 3 T magnetic resonance imaging of the brain. Patients also underwent otological, vestibular and audiometric examinations.

Lack of visualisation of the left and right vestibular aqueducts was identified as statistically significant amongst Ménière's disease patients (left, p = 0.0001, odds ratio = 0.02; right, p = 0.0004, odds ratio = 0.03). Both vestibular aqueducts were of abnormal size in the Ménière's disease group, albeit with left-sided significance (left, p = 0.008, odds ratio = 10.91; right, p = 0.49, odds ratio = 2.47).

Lack of vestibular aqueduct visualisation on magnetic resonance imaging was statistically significant in Ménière's disease patients compared to the general population. The study findings suggest that magnetic resonance imaging can be useful to rule out retrocochlear pathology and provide radiological data to support the clinical diagnosis of Ménière's disease.

Since the development of intratympanic aminoglycoside in the 1950s, otologists have been able to chemically ablate the vestibule. We present the results of using low-dose intratympanic gentamicin to treat Ménière's disease.

A retrospective review was performed of all patients who underwent low-dose intratympanic gentamicin therapy over seven years. Data on gender, age, number of procedures, pure tone audiometry and symptom control were analysed.

In all, 38 patients underwent low-dose intratympanic gentamicin therapy. These comprised 25 females and 13 males, with an average age of 58.4 years. Hearing was preserved in 87.5 per cent of patients, with no significant difference before and after treatment (p = 0.744). In all, 85.7 per cent of patients had complete or substantial symptom control (classes A and B, respectively).

Low-dose intratympanic gentamicin therapy was effective in controlling the symptoms of Ménière's disease patients, while preserving hearing.

This study aimed to investigate the long-term efficacy of intratympanic methylprednisolone perfusion treatment for intractable Ménière's disease.

A retrospective analysis of 17 intractable Ménière's disease patients treated with intratympanic methylprednisolone perfusion was performed. Treatment efficacy was evaluated according to the American Academy of Otolaryngology–Head and Neck Surgery criteria. Short and long-term control or improvement rates were calculated after 6 and 24 months, respectively.

Sixteen patients were followed for more than two years. Short- and long-term vertigo control rates were 94 per cent and 81 per cent, respectively; short- and long-term functional activity improvements were 94 per cent and 88 per cent, respectively. The pure tone average was 53 ± 14 dB before treatment, and 50 ± 16 dB at 6 months and 52 ± 20 dB at 24 months after intratympanic methylprednisolone perfusion. Tinnitus was controlled or improved in five patients over the two-year follow-up period.

Intratympanic methylprednisolone perfusion can effectively control vertigo and improve functional activity in intractable Ménière's disease patients with good hearing preservation. It may therefore be a viable alternative treatment for intractable Ménière's disease.

To determine the incidence of high jugular bulb in a group of patients with definite Ménière's disease, and to investigate whether the position or size of the jugular bulb is significantly different in the affected ear than in the unaffected ear.

Retrospective review of patient charts, audiograms, and computed tomography scans to determine the position and size of the jugular bulb in the affected and contralateral ears, as well as other abnormalities.

High jugular bulb was found in 57.1 per cent of affected ears. Encroachment of the cochlear and vestibular aqueducts was apparent in 39.3 per cent and 35.7 per cent, respectively, of affected ears. Diverticulum and dehiscence were observed in 28.6 per cent of affected ears. High jugular bulb was significantly associated with encroachment of the cochlear aqueduct (p = 0.003).

The mediolateral and anteroposterior position of the jugular bulb determines encroachment of the surrounding structures. An abnormal position is postulated to contribute to the development of Ménière's disease.

To determine the long-term efficacy of a fixed-dose intratympanic gentamicin treatment regime in controlling unilateral Ménière's disease.

Pfleiderer (1998) published two-year follow-up results for a series of 16 patients treated with a 4-day, 12-dose intratympanic gentamicin regime for unilateral Ménière's disease that was refractory to medical treatment. In 2010, a long-term telephone follow up (mean 17 years and 3 months) of this same cohort was conducted to determine long-term vertigo control. Of the 16 patients, 13 were eligible for the long-term follow up.

At 2 years' follow up, all 16 patients experienced substantial control of vertigo, with complete control achieved in 87 per cent of cases. At the long-term follow up, 9 of the 13 eligible patients were contactable, and all reported complete control of vertigo.

Fixed-dose intratympanic gentamicin controlled symptomatic unilateral Ménière's disease in both the short and long term.

To evaluate patient satisfaction and symptom improvement following treatment of Ménière's disease with the Meniett® device.

Retrospective, questionnaire-based audit and analysis of unilateral Ménière's disease patients’ records, following on from a previous study from our departments on intra-tympanic gentamicin for Ménière's disease, using the Vertigo Symptom Scale and Glasgow Benefit Inventory as outcome measures.

Of 33 consecutive patients treated with the Meniett® device for four to six weeks, 30 responded to the questionnaires (90.9 per cent). Respondents’ mean Vertigo Symptom Scale score was 0.7 (range 0–2.1), and their mean Glasgow Benefit Inventory general subscale score was 24.1. Nineteen (63.3 per cent) patients felt that the device had alleviated their vertigo and tinnitus.

This is the first UK study of the effectiveness of the Meniett® device in treating Ménière's disease. It shows that the Meniett® device is a well tolerated, useful and minimally invasive means of treating Ménière's disease after medical treatment has failed, and before more potentially cochleo- and vestibulo-toxic therapies and invasive procedures are utilised.

To study the effects of hypobaric pressure chamber exposure on the cochlear frequency selectivity of subjects with monaural, fluctuating, low-frequency hearing loss, such as occurs in Ménière's disease.

We used a hypobaric pressure chamber to create relative underpressure in the ear canal, in order to impose positive pressure gradients on the inner ear. Psychophysical tuning curves, transiently evoked otoacoustic emissions and speech recognition scores in noise were measured in 10 subjects with fluctuating, low-frequency hearing loss, before and after pressure exposure.

After the exposure, subjects’ overall pure tone averages showed no improvement, but individual results showed improved speech recognition scores in noise (six subjects), increased transiently evoked otoacoustic emission strength (three subjects) and increased psychophysical tuning curve steepness (two subjects). Deteriorations were also seen, mainly in psychophysical tuning curves. No association could be established between the different tests, and the measured parameters could not predict subjective improvement.

The results suggest variable effects of hypobaric pressure exposure on inner-ear physiology.

Ménière's disease is not uncommon, with an incidence in Caucasians of about one in 2000. The incidence peaks in the fifth decade. Cases are usually isolated or sporadic, but in perhaps five per cent other family members are affected. We report here the clinical and genetic characteristics of a comprehensive set of familial Ménière's disease cases from the UK.

Forty-six affected families were studied. All cases were diagnosed using the American Academy of Otolaryngology–Head and Neck Surgery committee on hearing and equilibrium 1995, or more stringent, criteria.

Autosomal dominant inheritance with reduced penetrance was the most likely mode of inheritance overall. Apparent genetic anticipation was observed, but may also be a result of ascertainment bias given the collection strategy. There was also a slight tendency for cases to result from maternal transmission within the families in this set. The family pedigrees are presented, and the authors have also set up a website at which all the pedigrees may be viewed in greater detail.

Ménière's disease is a diagnosis requiring expert clinical judgment. There are several differences between the American Academy of Otolaryngology Head and Neck Surgery diagnostic guidelines and Prosper Ménière's original description of the disease.

Six hundred and fifty patients attending a specialist balance clinic had their clinical profiles fully analysed according to each set of diagnostic criteria.

Application of the American Academy of Otolaryngology Head and Neck Surgery guidelines resulted in the diagnosis of three times more patients than did use of Ménière's diagnostic criteria. Treatment options for patients in both groups were similar. It is unlikely that the application of different diagnostic criteria would have an effect on the treatment of individual patients.

The American Academy of Otolaryngology Head and Neck Surgery guidelines are more sensitive and less specific in diagnosing Ménière's disease than Prosper Ménière's original description. Standardised criteria should be applied across published series, in order to make results accurate, comparable and useful in the long term. We would recommend the introduction of a stricter diagnostic category for definite Ménière's disease.

The objectives of this preliminary, prospective, cohort study were to ascertain the characteristics of vestibular evoked myogenic potentials at threshold levels in two groups of Ménière's disease patients – acute and stable – and to identify whether vestibular evoked myogenic potentials can provide any specific, objective information to distinguish acute from stable Ménière's disease.

The study was based at a tertiary neuro-otology centre. Twenty adult patients who fulfilled the American Academy of Otolaryngology–Head and Neck Surgery1 criteria for Ménière's disease were divided into two groups: 11 patients with acute Ménière's disease and nine patients with stable Ménière's disease. Eighteen healthy adult volunteers served as controls. All subjects underwent vestibular evoked myogenic potential testing with ipsilateral, short tone burst stimuli at 500 Hz, as well as pure tone audiometry. The patients also underwent caloric testing.

Vestibular evoked myogenic potentials were present in all controls, and were present in 65 per cent of patients but absent in 35 per cent. The mean absolute threshold (Tvestibular evoked myogenic potential) ± standard deviation in normal controls was 116 ± 7.7 dBSPL; this did not differ statistically from that in patients, nor did it differ between acute and stable Ménière's disease. The p13/n23 latencies at the threshold levels in the normal, acute and stable groups (mean ± standard deviation) were respectively: 15 ± 2.2 ms/23.0 ± 2.5 ms; 15.7 ± 0.9 ms/23.7 ± 0.9 ms; and 15.3 ± 2.0 ms/24.2 ± 1.9 ms. The mean interaural amplitude difference ratio (IAD) ± standard deviation was significantly higher in the stable group compared with the acute group (0.54 ± 0.33 vs −0.15 ± 0.22; p = 0.007) and with the controls (0.54 ± 0.33 vs 0.1 ± 0.22; p = 0.05).

The parameter that best differentiated acute from stable Ménière's disease at threshold was the interaural amplitude difference ratio. Therefore, this parameter may be used to monitor the clinical course of Ménière's disease.