From the Guidelines
Diagnosing Meniere's disease involves evaluating a combination of characteristic symptoms, including recurring episodes of vertigo lasting 20 minutes to 12 hours, fluctuating or nonfluctuating sensorineural hearing loss, tinnitus, or pressure in the affected ear, and ruling out other conditions 1. The diagnosis is primarily based on the presence of these symptoms, with a focus on documenting at least two episodes of vertigo and hearing loss, as well as tinnitus or aural fullness in the affected ear.
- A healthcare provider will typically perform a detailed medical history and physical examination to identify these symptoms and rule out other conditions.
- Specialized tests, such as audiometry to document hearing loss, may be conducted to support the diagnosis 1.
- Imaging studies like MRI may be offered to patients with nonfluctuating sensorineural hearing loss, tinnitus, or pressure in the affected ear, to rule out other conditions such as acoustic neuroma or multiple sclerosis 1.
- Clinicians should not routinely order vestibular function testing or electrocochleography to establish the diagnosis of Ménière's disease 1. The diagnosis is considered definite when a patient has experienced at least two spontaneous episodes of vertigo lasting at least 20 minutes, has documented hearing loss on at least one occasion, and experiences tinnitus or aural fullness in the affected ear, with other causes excluded 1.
- The combination of symptoms, test results, and exclusion of other conditions leads to the diagnosis, with a focus on improving accuracy and efficiency of diagnosis, and reducing misdiagnosis 1.
From the Research
Diagnosis of Meniere Disease
To diagnose Meniere disease, several tests and assessments can be used, including:
- Vestibular-evoked myogenic potentials (VEMP) 2, 3, 4, 5
- Electrocochleography (ECochG) 3, 4, 5
- Video head-impulse test 2, 3
- Caloric testing 2, 3
- Audiometry 2, 3, 4
- Inner ear MRI after intravenous injection of gadolinium 4
- Otoacoustic emissions (OAEs) 4, 5
- Assessment of nystagmus, including ictal and interictal nystagmus 2, 3
Clinical Presentation
Meniere disease is characterized by recurrent vertigo and fluctuating aural symptoms, including:
- Tinnitus 3, 6
- Subjective hearing loss 3, 6
- Aural fullness 3
- Vertigo 2, 3, 6
- Imbalance or disequilibrium 2
- Drop attacks 2
Diagnostic Challenges
Diagnosing Meniere disease can be challenging, particularly in cases with atypical presentations or normal vestibular function and hearing 2, 3, 6. The use of multiple tests and assessments can help support a clinical diagnosis, but none of the electrophysiological tests can be considered pathognomonic for Meniere disease 5.