What is the appropriate workup for left-sided sinusitis versus possible Meniere's disease?

From the Guidelines

The appropriate workup for differentiating left-sided sinusitis from Meniere's disease begins with a thorough history and physical examination focusing on specific symptoms, and for sinusitis, CT imaging of the sinuses is recommended to visualize mucosal thickening, air-fluid levels, or obstruction of the ostiomeatal complex, as stated in the clinical practice guideline for adult sinusitis 1.

Key Differentiating Features

The key distinguishing features between sinusitis and Meniere's disease are:

• Sinusitis typically presents with facial pain/pressure, nasal congestion, and discharge
• Meniere's disease manifests as episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness
• Timing is also important - sinusitis symptoms are usually continuous while Meniere's symptoms are episodic

Diagnostic Approach

For sinusitis, the following diagnostic approaches are recommended:

• Nasal endoscopy to visualize the nasal cavity and sinuses
• CT imaging of the sinuses to visualize mucosal thickening, air-fluid levels, or obstruction of the ostiomeatal complex
• Laboratory tests, such as CBC, to check for elevated white blood cells indicating infection For Meniere's disease, the following diagnostic approaches are recommended:
• Audiometric testing, including pure tone audiometry, speech discrimination, and tympanometry to document the characteristic low-frequency sensorineural hearing loss
• Electrocochleography to show increased summating potential/action potential ratio
• Vestibular testing, such as videonystagmography and rotary chair testing, to assess vestibular function
• MRI of the internal auditory canal with gadolinium to rule out acoustic neuroma or other central pathologies, as recommended in the clinical practice guideline for Meniere's disease 1

Treatment Planning

A comprehensive approach to diagnosis and treatment planning is essential for these conditions with overlapping symptoms, and treatment approaches should be based on the most recent and highest quality evidence, such as the clinical practice guideline for adult sinusitis 1 and the clinical practice guideline for Meniere's disease 1.

From the Research

Workup for Left-Sided Sinusitis versus Possible Meniere's Disease

• The workup for left-sided sinusitis typically involves imaging studies such as CT or MRI scans to evaluate the sinuses, as well as a thorough medical history and physical examination to rule out other causes of symptoms 2.
• In contrast, the workup for Meniere's disease involves a combination of audiometry, contrast-enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, such as otosyphilis, autoimmune inner ear disease, and temporal bone tumors 2.
• The diagnosis of Meniere's disease is based on clinical criteria, including episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus, and/or fullness) in the affected ear 3.
• A key distinction between left-sided sinusitis and Meniere's disease is the presence of vertigo and hearing loss in Meniere's disease, which is not typically seen in sinusitis 4, 5.
• The affected ear in Meniere's disease can be either unilateral or bilateral, with the left ear being affected in approximately 50-60% of cases 4.

Diagnostic Criteria for Meniere's Disease

• The diagnostic criteria for Meniere's disease include definite Meniere's disease and probable Meniere's disease, with definite Meniere's disease requiring the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms in the affected ear 3.
• Probable Meniere's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 minutes to 24 hours 3.
• The duration of vertigo episodes in Meniere's disease is limited to a period between 20 minutes and 12 hours, which can help distinguish it from other causes of vertigo 3.

Treatment and Management

• Treatment for Meniere's disease typically begins with conservative measures, including a low-salt diet, avoidance of stress and caffeine, and sleep hygiene, followed by medical therapy with a diuretic if symptoms persist 2.
• Other treatment options for Meniere's disease include intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery, as well as vestibular neurectomy and labyrinthectomy in severe cases 2, 6.