From the Guidelines
The initial workup for a patient with suspected Meniere's disease should include a comprehensive history and physical examination, audiometric testing, and imaging studies to rule out other conditions. Begin with a detailed history focusing on the classic tetrad of symptoms: episodic vertigo lasting 20 minutes to several hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness 1. The physical examination should include otoscopy, cranial nerve assessment, and tests for nystagmus such as the Dix-Hallpike maneuver.
Key Components of the Initial Workup
- A comprehensive history to identify the classic symptoms of Meniere's disease
- Physical examination to assess for signs of vestibular dysfunction and other potential causes of symptoms
- Audiometric testing, which is essential for diagnosing Meniere's disease and typically reveals low-frequency sensorineural hearing loss that fluctuates over time 1
- Imaging studies, such as MRI of the brain with contrast, to exclude other pathologies such as vestibular schwannoma or multiple sclerosis
Additional Testing
Additional testing may include vestibular function tests, such as electronystagmography (ENG) or videonystagmography (VNG), and laboratory tests, such as basic blood work, thyroid function tests, and syphilis serology, to rule out other conditions that may mimic Meniere's disease 1. However, vestibular function testing or electrocochleography should not be routinely ordered to establish the diagnosis of Meniere's disease 1.
Importance of Accurate Diagnosis
Accurate diagnosis is crucial to ensure appropriate management and treatment of Meniere's disease. A comprehensive approach is necessary because Meniere's disease remains a clinical diagnosis of exclusion, with no single definitive test available for confirmation. By following this approach, clinicians can provide the best possible care for patients with suspected Meniere's disease and improve their quality of life.
From the Research
Initial Workup for Suspected Meniere's Disease
The initial workup for a patient with suspected Meniere's disease includes:
- A detailed patient history to identify characteristic symptoms such as discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, aural fullness, and tinnitus 2
- Audiometry to assess hearing loss 2, 3
- A contrast-enhanced MRI of the internal auditory canals to rule out other conditions 2
- Exclusion of other diseases that can produce similar symptoms, such as otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors 2
Additional Considerations
- A history of migraine should be sought due to the high rate of co-occurrence with Meniere's disease 2
- Laboratory tests may be useful in tailoring and following up patients, but the diagnosis is primarily based on clinical presentation and history 3
- The clinical picture of Meniere's disease can fluctuate, and individually, subsidiary examinations may become impotent in diagnosing Meniere's disease 4
Diagnostic Approach
- A protocol for diagnosis should be established, beginning with a detailed history taking and guided by the patient's symptoms 4
- Patients with Meniere's disease should be followed closely by their ear, nose, and throat doctor, with regular clinical visits and audiovestibular workups 4
- Monitoring the course of the disease can help detect early changes in symptoms and/or test results, allowing for early intervention and minimizing sequelae from spells of hydrops 4