Menière's disease: differential diagnosis and treatment.

Menière's disease may be the underlying cause of dizziness, which is a common presenting complaint. This disease is differentiated from other causes of dizziness by its classic constellation of four symptoms; dizziness characterized as episodic spinning or whirling vertigo; fluctuating, low-frequency sensorineural hearing loss; tinnitus, and a sensation of fullness in the ear. Because these symptoms may or may not develop or occur simultaneously, a careful history and a complete physical examination are necessary for diagnosis. If Menière's disease is present but untreated for 10 or more years, hearing may deteriorate as the vertiginous episodes gradually subside. Medical management includes sodium restriction and the avoidance of caffeine, alcohol and nicotine. Diuretics, antiemetics, antidepressants and vestibular suppressants may be prescribed, and surgery may be considered in severe, unresponsive cases.