Ménière’s disease (MD) is a chronic vestibular disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss (SNHL), tinnitus, and aural fullness, with an unpredictable course that can significantly impair quality of life. Endolymphatic hydrops (EH) remains the hallmark histopathological finding; however, its underlying pathophysiology is not fully understood and likely reflects a multifactorial process involving immune, viral, allergic, genetic/familial, and vascular mechanisms. Emerging evidence suggests that EH may represent a secondary manifestation rather than the primary driver of symptoms, potentially resulting from endolymphatic sac hyperplasia. Given this complexity, no single unifying mechanism has been confirmed, and etiologic contributors may vary among patients. Presenting a clinical case, therefore, provides valuable insight into this heterogeneity and highlights the need for continued research to clarify the underlying pathology of MD. This report presents a 57-year-old male with recurrent vertigo, progressive moderately severe right-sided SNHL, tinnitus, and severe vitamin D deficiency. Diagnostic pure-tone audiometry, comprehensive vestibular testing, and imaging were performed. Management consisted of lifestyle and dietary modifications, pharmacologic therapy, vestibular rehabilitation, vitamin D supplementation, and hearing aid rehabilitation, resulting in improved vertigo control, balance, and overall quality of life. The discussion integrates current diagnostic criteria, differential considerations, and evidence-based management strategies, emphasizing individualized, patient-centered care and the importance of recognizing emerging modifiable factors such as vitamin D deficiency and potential genetic susceptibility. The central aim of this case report is to enhance medical students' understanding of this multifaceted disorder and to underscore the clinical reasoning skills required for accurate and timely diagnosis.
Authors: Manal M. El Faham, Reham Elrashidy
Publish Year: 2026
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