First-year resident in the Department of Otolaryngology-Head and Neck Surgery at the University of Toronto in Ontario.
Medical student in the Department of Otolaryngology at Queen's University in Kingston, Ont.
Can Fam Physician. 2019 Jul;65(7):463-467.
To provide family physicians with an updated approach to the diagnosis and management of Ménière disease (MD), detailing the natural course of MD and describing how to initiate medical therapy while awaiting consultation with otolaryngology-head and neck surgery.
The approach is based on the authors' clinical practices and review articles from 1989 to 2018. Most of the cited studies provided level II or III evidence.
Ménière disease is an uncommon disorder of the inner ear causing vertigo attacks with associated unilateral hearing loss, tinnitus, and aural fullness. It has a degenerative course that often results in permanent sensorineural hearing loss. On average, MD stabilizes with no further vestibular attacks by about 8 years after the onset of symptoms; however, this is highly variable. Vertigo symptoms can be controlled through a combination of dietary salt restriction, stress reduction, and medical therapy (betahistine, diuretics, or both). These can be initiated by family physicians before consultation with otolaryngology-head and neck surgery. Symptoms refractory to such strategies can be treated using nonablative, and occasionally ablative, therapies.
A thorough history is key to the approach to and management of MD and permits differentiating MD from other vestibular and nonvestibular conditions.
为家庭医生提供梅尼埃病（MD）的诊断和管理的最新方法，详细介绍 MD 的自然病程，并描述如何在等待耳鼻喉头颈外科会诊的同时开始药物治疗。
该方法基于作者的临床实践和 1989 年至 2018 年的综述文章。大多数引用的研究提供了 II 级或 III 级证据。
梅尼埃病是一种罕见的内耳疾病，引起眩晕发作，伴有单侧听力损失、耳鸣和耳闷。它具有退行性病程，通常导致永久性感觉神经性听力损失。平均而言，MD 在症状出现后约 8 年左右稳定，不再出现前庭发作；然而，这是高度可变的。眩晕症状可以通过饮食中盐的限制、减轻压力和药物治疗（倍他司汀、利尿剂或两者联合）来控制。这些可以由家庭医生在与耳鼻喉头颈外科会诊之前开始。对于无法通过这些策略控制的症状，可以使用非消融和偶尔消融治疗。
详细的病史是 MD 处理和管理的关键，可将 MD 与其他前庭和非前庭疾病区分开来。
