From the Guidelines
Meniere's disease is diagnosed based on specific criteria that include recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness, with at least two spontaneous episodes of vertigo lasting 20 minutes to 12 hours, documented hearing loss, and tinnitus or aural fullness in the affected ear, as stated in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Diagnostic Criteria
The diagnostic criteria for Meniere's disease include:
- Recurrent episodes of vertigo lasting 20 minutes to 12 hours
- Fluctuating sensorineural hearing loss
- Tinnitus or aural fullness in the affected ear
- Symptoms not better explained by another vestibular diagnosis
Clinical Evaluation
The diagnosis of Meniere's disease is primarily clinical, with no single definitive test available.
- Audiometric testing typically shows low-frequency sensorineural hearing loss that fluctuates over time
- Electrocochleography may show an elevated summating potential to action potential ratio
- MRI is often performed to exclude other conditions like vestibular schwannoma
- Video nystagmography or electronystagmography may demonstrate a reduced vestibular response on the affected side
Pathophysiology
The pathophysiology of Meniere's disease involves endolymphatic hydrops, an excessive accumulation of fluid in the inner ear, though the exact mechanism remains unclear, as noted in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Treatment Goals
The goals of treatment for Meniere's disease are to prevent or reduce the severity and frequency of vertigo attacks, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve overall quality of life, as stated in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
From the Research
Diagnostic Criteria for Meniere's Disease
The diagnostic criteria for Meniere's disease are based on clinical criteria and can be categorized into two types: definite Meniere's disease and probable Meniere's disease 2, 3, 4.
- Definite Meniere's disease is diagnosed when there is an 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 2, 3, 4.
- 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 2, 3, 4.
Clinical Characteristics
The clinical characteristics of Meniere's disease include:
- Episodic vertigo lasting 20 minutes to 12 hours 2, 3, 4
- Low- to medium-frequency sensorineural hearing loss 2, 3, 4
- Fluctuating aural symptoms such as hearing loss, tinnitus, and/or fullness in the affected ear 2, 3, 4
- Aural fullness and tinnitus 5, 6
Diagnosis
The diagnosis of Meniere's disease is made with a characteristic patient history, including discrete episodes of vertigo, accompanied by sensorineural hearing loss, aural fullness, and tinnitus 5. The diagnosis can also be supported by findings on audiometry and MRI of the inner ear 5, 6.