Symptoms of Ménière's Disease
Ménière's disease is characterized by four primary symptoms: spontaneous attacks of vertigo lasting 20 minutes to 12 hours, fluctuating low- to mid-frequency sensorineural hearing loss, tinnitus, and aural fullness (sensation of pressure or fullness in the affected ear). 1
Core Diagnostic Symptoms
Vertigo
- Episodes of rotational vertigo (spinning sensation)
- Duration: 20 minutes to 12 hours
- Spontaneous onset
- Often accompanied by:
- Nausea and vomiting
- Imbalance
- Difficulty standing or walking during attacks 1
Hearing Symptoms
- Fluctuating sensorineural hearing loss
- Initially affects low to mid-frequencies
- May become permanent as disease progresses
- Documented audiometrically before, during, or after vertigo episodes
- Tinnitus (ringing, buzzing, or roaring in the ear)
- May fluctuate in intensity
- Often worsens during or before attacks
- Aural fullness (pressure or plugging sensation in the ear) 1, 2
Additional Manifestations
Later-Stage Symptoms
- Drop attacks (Tumarkin's Otolithic Crisis)
- Sudden falls without warning
- No loss of consciousness
- Not present in all patients
- Typically occurs in later stages of the disease 1
Disease Progression
- Initially, symptoms fluctuate and may resolve between attacks
- As disease progresses:
- Vertigo attacks may become less frequent
- Hearing loss and tinnitus often become permanent
- Balance problems may become chronic 3
Distinguishing Features from Other Vestibular Disorders
Ménière's disease must be differentiated from other conditions with similar presentations:
| Condition | How It Differs from Ménière's Disease |
|---|---|
| Benign paroxysmal positional vertigo (BPPV) | Vertigo lasts seconds, not hours; triggered by position changes; no hearing loss or aural fullness |
| Vestibular migraine | May have shorter or longer attacks; less likely to have hearing loss; often has history of migraine; more photophobia |
| Vestibular neuritis | Prolonged vertigo (days); no hearing loss or aural fullness |
| Labyrinthitis | Prolonged vertigo with sudden hearing loss; not episodic or fluctuating |
| Vestibular schwannoma | Chronic imbalance rather than episodic vertigo; hearing loss typically doesn't fluctuate |
| Stroke/ischemia | May have other neurological symptoms; usually no associated hearing loss or tinnitus [1] |
Clinical Diagnostic Criteria
For a definitive diagnosis of Ménière's disease, all of these must be present:
- Two or more spontaneous attacks of vertigo, each lasting 20 minutes to 12 hours
- Audiometrically documented fluctuating low- to mid-frequency sensorineural hearing loss in the affected ear on at least one occasion before, during, or after one of the episodes of vertigo
- Fluctuating aural symptoms (hearing loss, tinnitus, or fullness) in the affected ear 1
Important Considerations
- Physical examination findings between attacks are often unremarkable
- Symptoms may affect one or both ears (bilateral in approximately 10-50% of cases)
- The underlying pathology involves endolymphatic hydrops (excessive fluid in the inner ear) 2
- Symptoms can significantly impact quality of life, causing anxiety, depression, and social isolation 1
Understanding these characteristic symptoms is crucial for early diagnosis and appropriate management to improve quality of life and potentially slow disease progression.