From the Guidelines
Meniere's disease is characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness or pressure in the affected ear, with vertigo attacks typically lasting from 20 minutes to 12 hours, as defined by the American Academy of Otolaryngology-Head and Neck Surgery 1. The symptoms of Meniere's disease can be unpredictable and vary in severity, with some patients experiencing severe vertigo, nausea, and vomiting, while others may have milder symptoms.
- The vertigo attacks can last from 20 minutes to several hours and can be severe enough to cause nausea and vomiting.
- Hearing loss often affects low frequencies first and may become permanent over time as the disease progresses.
- Tinnitus presents as a ringing, roaring, or buzzing sound in the ear, while aural fullness feels like pressure or congestion.
- These symptoms occur in unpredictable episodes, with symptom-free periods between attacks. The disease typically affects only one ear initially, though it may progress to both ears in about 30-50% of patients, and results from an abnormal amount of endolymph fluid in the inner ear, disrupting balance and hearing signals to the brain, as noted in the clinical practice guideline for Meniere's disease 1. Diagnosis typically requires experiencing multiple vertigo episodes lasting at least 20 minutes, documented hearing loss, and either tinnitus or aural fullness, with other potential causes ruled out, according to the American Academy of Otolaryngology-Head and Neck Surgery 1. The exact cause of Meniere's disease remains unclear, though factors like autoimmune responses, viral infections, genetic predisposition, and improper fluid drainage may contribute, as discussed in the clinical practice guideline for Meniere's disease 1. The diagnosis of Meniere's disease should be based on a thorough clinical evaluation, including a detailed history and physical examination, as well as audiometric testing and other diagnostic tests as needed, to rule out other potential causes of the symptoms, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
From the Research
Signs and Symptoms of Meniere's Disease
The signs and symptoms of Meniere's disease include:
- Episodic vertigo, characterized as spinning or whirling, lasting 20 minutes or longer 2, 3, 4, 5
- Fluctuating, low-frequency sensorineural hearing loss, typically affecting low frequencies at first 2, 3, 4, 5
- Tinnitus, or ringing in the ear 2, 3, 4, 5
- Aural fullness, or a sensation of fullness in the ear 2, 3, 4, 5
- Headache, which may occur during attacks 2
- Bilateral involvement, found in 25-40% of cases 2
Diagnostic Criteria
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 loss, tinnitus, and/or fullness) in the affected ear 2
- A characteristic patient history, including discrete episodes of vertigo, accompanied by sensorineural hearing loss, aural fullness, and tinnitus 4
- Audiologic and vestibular assessment to monitor the clinical course 2
- Functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography, or head impulse tests 3
- MRI to directly visualize endolymphatic hydrops in the cochlea, vestibule, and semicircular canals 3