Meniere's Disease

Meniere's disease is characterized by endolymphatic hydrops resulting from impaired endolymph homeostasis. The endolymphatic sac, responsible for endolymph reabsorption and immune surveillance, becomes dysfunctional through mechanisms including autoimmune inflammation, viral damage, anatomical obstruction of the endolymphatic duct, or genetic predisposition affecting aquaporin channels and ion transport. Progressive distension of the scala media distorts the organ of Corti, disrupting frequency-specific cochlear tonotopy and producing the characteristic low-frequency hearing loss. Episodic membrane ruptures cause potassium intoxication of vestibular and cochlear hair cells. The clinician must differentiate Meniere's from vestibular migraine (the most common mimicker), autoimmune inner ear disease, vestibular schwannoma, syphilitic labyrinthitis, and superior canal dehiscence syndrome. Management includes initiating stepped pharmacotherapy, ordering and interpreting audiometric and vestibular testing, prescribing intratympanic therapies for refractory cases, and coordinating surgical referrals.