Management of Meniere’s syndrome
• Commonest in 30–50 age group
• Characterised by paroxysmal attacks of:
– vertigo
– tinnitus
– nausea and vomiting
– sweating and pallor
– deafness (progressive)
• Abrupt onset—patient may fall
• Head movements avoided—often bedridden
• Attacks last 30 mins to several hours
• Nystagmus observed only during an attack
• Examination:
– sensorineural deafness
– caloric test-impaired vestibular function
– audiometry
• sensorineural deafness
• loudness recruitment
Note: Tends to be overdiagnosed.
Treatment (acute attack) IV diazepam 5 mg or IM prochlorperazine 12.5 mg.
Many use these drugs in combination.
Treatment (long term)
• Reassurance with a very careful explanation of this condition to the
patient who often associates it with malignant disease
• Avoid excessive intake of salt (especially), tobacco and coffee
• Alleviate anxiety by using long-term sedation
• Referral for a neurological assessment
• Diuretic (e.g. Hygroton, Moduretic)
• Consider betahistadine (Serc) 8 mg (o) 8 hrly to prevent attacks
Surgery may be an option for intractable cases.
Recurrent vestibulopathy
• Episodic vertigo ± vomiting of similar duration to Meniere’s
• No hearing loss, tinnitus or focal neurological signs
• Peak age 30–50 yrs, M = F
• Aetiology unknown
Treatment is symptomatic.
Dizzy turns in elderly women
If no cause such as hypertension is found, advise them to get up slowly
from sitting or lying and to wear fi rm elastic stockings.
Dizzy turns in girls in late teens
• Common due to blood pressure fl uctuations
• Give advice related to stress, lack of sleep or excessive activity
• Reassure that it settles with age (rare after 25 yrs)
• Commonest in 30–50 age group
• Characterised by paroxysmal attacks of:
– vertigo
– tinnitus
– nausea and vomiting
– sweating and pallor
– deafness (progressive)
• Abrupt onset—patient may fall
• Head movements avoided—often bedridden
• Attacks last 30 mins to several hours
• Nystagmus observed only during an attack
• Examination:
– sensorineural deafness
– caloric test-impaired vestibular function
– audiometry
• sensorineural deafness
• loudness recruitment
Note: Tends to be overdiagnosed.
Treatment (acute attack) IV diazepam 5 mg or IM prochlorperazine 12.5 mg.
Many use these drugs in combination.
Treatment (long term)
• Reassurance with a very careful explanation of this condition to the
patient who often associates it with malignant disease
• Avoid excessive intake of salt (especially), tobacco and coffee
• Alleviate anxiety by using long-term sedation
• Referral for a neurological assessment
• Diuretic (e.g. Hygroton, Moduretic)
• Consider betahistadine (Serc) 8 mg (o) 8 hrly to prevent attacks
Surgery may be an option for intractable cases.
Recurrent vestibulopathy
• Episodic vertigo ± vomiting of similar duration to Meniere’s
• No hearing loss, tinnitus or focal neurological signs
• Peak age 30–50 yrs, M = F
• Aetiology unknown
Treatment is symptomatic.
Dizzy turns in elderly women
If no cause such as hypertension is found, advise them to get up slowly
from sitting or lying and to wear fi rm elastic stockings.
Dizzy turns in girls in late teens
• Common due to blood pressure fl uctuations
• Give advice related to stress, lack of sleep or excessive activity
• Reassure that it settles with age (rare after 25 yrs)