Meniere's disease is a disorder associated with an increased volume of endolymph within the cochlea and labyrinth. It occurs equally in men and women, with onset in middle age. The disease is usually unilateral to begin with and often becomes bilateral over time. The precise pathogenesis is unknown, but evidence suggests that patients have difficulty regulating the volume, flow, and composition of endolymph. Histologic studies have demonstrated that the endolymphatic sac contains immunologically active tissue, raising the possibility of an autoimmune mechanism. As with BPPV, the onset of vertigo is usually sudden. However, the duration of vertigo ranges from 20 min to 12 h (typically 2 to 8 h). It is associated with nausea, vomiting, and diaphoresis. The frequency of attacks can vary from several times per week to several times per month. Between attacks, the patient is usually well, although deafness may persist. Other hallmarks of the diagnosis include associated symptoms such as roaring tinnitus, diminished hearing, and fullness in one ear. Current treatments offer symptomatic relief without altering the course of the disease.
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