What diagnostic tests are used for Meniere's disease?

Diagnostic Tests for Ménière's Disease

Ménière's disease is primarily a clinical diagnosis based on patient-reported symptoms and audiometric data, and does not require routine vestibular function testing or electrocochleography (ECochG) for diagnosis. 1

Core Diagnostic Criteria

Clinical Criteria for Definite Ménière's Disease

• Two or more spontaneous attacks of vertigo, each lasting 20 minutes to 12 hours 1
• Audiometrically documented fluctuating low- to mid-frequency sensorineural hearing loss in the affected ear on at least one occasion before, during, or after an episode of vertigo 1
• Fluctuating aural symptoms (hearing loss, tinnitus, or fullness) in the affected ear 1

Essential Diagnostic Tests

Audiometric Testing

• An audiogram is mandatory when assessing a patient for the diagnosis of Ménière's disease 1
• Should include pure tone thresholds and measures of speech recognition 1
• Should rule out or quantify any conductive component of hearing loss 1
• Should include word recognition/discrimination score (WRS) in each ear 1
• Helps establish baseline hearing prior to treatment and directs treatment options based on degree of residual hearing 1

MRI Imaging

• MRI of the internal auditory canals is recommended to rule out other conditions that may mimic Ménière's disease, such as vestibular schwannoma 1, 2
• Non-contrast MRI has been proposed as a cost-effective means to evaluate for vestibular schwannoma and other causes of unilateral sensorineural hearing loss 1

Tests That Should NOT Be Routinely Ordered

Vestibular Function Testing

• Clinicians should not routinely order vestibular function testing to establish the diagnosis of Ménière's disease 1
• Tests include videonystagmography (VNG) with caloric testing, rotary chair, video head impulse testing (vHIT), and vestibular evoked myogenic potentials (cVEMP and oVEMP) 1
• Results often fluctuate throughout the course of Ménière's disease and correlate poorly with patient-perceived disability 1
• Normal vestibular test results do not rule out Ménière's disease 1, 3
• Unnecessary vestibular testing can lead to delays in diagnosis, increased costs, and patient discomfort 1, 3

Electrocochleography (ECochG)

• Should not be routinely ordered to establish the diagnosis of Ménière's disease 1
• Measures electrical responses of the cochlea and auditory nerve to acoustic stimulation 1
• Results fluctuate throughout the course of Ménière's disease 1
• Current data do not support consistent high sensitivity and specificity to diagnose Ménière's disease 1

When Additional Testing May Be Appropriate

• When diagnosis of vertigo/dizziness is unclear 3
• When clinical presentation is atypical 3, 4
• When multiple concurrent peripheral vestibular disorders are suspected 3
• When patients remain symptomatic following treatment 3

Differential Diagnosis Considerations

Vestibular Migraine

• Clinicians should determine if patients meet diagnostic criteria for vestibular migraine when assessing for Ménière's disease 1
• Vestibular migraine is highly prevalent (2.7% in population studies and 10% in outpatient clinics) 1
• Up to 35% of Ménière's disease patients may also meet criteria for definite or probable vestibular migraine 1

Common Pitfalls and Caveats

• Relying on vestibular testing or ECochG for diagnosis can delay treatment initiation and increase costs 1, 3
• Normal vestibular test results do not rule out Ménière's disease 1, 3
• Atypical presentations with normal vestibular function and hearing can be a diagnostic challenge 4
• Unnecessary testing can contribute to patient discomfort, including nausea and vertigo during testing 3
• Waiting for specialized tests to be completed may delay initiation of treatment 1

Research Developments

• MRI has been optimized to directly visualize endolymphatic hydrops in the cochlea, vestibule, and semicircular canals 5
• Delayed inner ear MRI after intravenous gadolinium injection can detect endolymphatic hydrops, but correlation with clinical symptoms is variable 6
• Combined use of shift-distortion product otoacoustic emissions (shift-DPOAEs) and ECochG may enhance diagnostic confidence in some cases 6