From the Guidelines
Testing for Ménière's disease typically involves a combination of medical history assessment, physical examination, and specialized tests, with audiometry being a crucial diagnostic tool, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. To diagnose Ménière's disease, the following steps are taken:
- A thorough medical history assessment to evaluate symptoms, particularly episodes of vertigo, hearing loss, tinnitus, and ear fullness.
- A physical examination to assess overall health and rule out other conditions.
- Specialized tests, including:
- Audiometry to measure hearing function, which often shows low-frequency sensorineural hearing loss in Ménière's.
- Electrocochleography (ECoG) to measure inner ear fluid pressure.
- Videonystagmography (VNG) or electronystagmography (ENG) to assess balance function.
- Rotary chair testing to evaluate vestibular function.
- MRI scans to rule out other conditions like acoustic neuroma.
- Blood tests to exclude other disorders with similar symptoms. According to the clinical practice guideline for Ménière's disease, clinicians should obtain an audiogram when assessing a patient for the diagnosis of Ménière's disease, as it is a strong recommendation based on systematic reviews of cross-sectional studies with consistently applied reference standard and blinding for diagnostic testing with a preponderance of benefit over harms 1. It is essential to note that no single test definitively diagnoses Ménière's disease, and diagnosis is often based on recurring symptom patterns and ruling out other conditions. The American Academy of Otolaryngology-Head and Neck Surgery defines Ménière's as two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, documented hearing loss on at least one occasion, and tinnitus or ear fullness in the affected ear, with other causes excluded 1.
From the Research
Testing for Meniere's Disease
To test for Meniere's disease, several methods can be employed, including:
- Vestibular-evoked myogenic potentials (VEMP) 2, 3, 4
- Electrocochleography (EcochG) 2, 4
- Video head-impulse test 5, 3
- Caloric testing 5
- Audiometry 5, 3, 4
- Inner ear MRI after intravenous injection of gadolinium 4
- Phase shift of distortion product otoacoustic emissions (shift-DPOAEs) 4
- Cervical vestibular-evoked myogenic potentials (cVEMP) 4
Sensitivity and Specificity of Tests
The sensitivity and specificity of these tests vary:
- VEMP: sensitivity of 63.6% and specificity of 100% 2
- EcochG: sensitivity of 37.5-63.6% and specificity of 84.6-100% 2
- Video head-impulse test: abnormal results in 12.7% of patients 5
- Caloric testing: abnormal results in 69.6% of patients 5
- Audiometry: mean pure-tone averages of 50 dB and 20 dB for affected and unaffected ears, respectively 5
Comprehensive Battery of Tests
A comprehensive battery of auditory and vestibular tests can aid in evaluating inner ear deficits and grading the severity of Meniere's disease 3. This includes:
- Audio-vestibular tests to verify the involvement of vestibular organs
- Correlations between DHI scores, number of vertigo attacks, audio-vestibular function, and the number of involved vestibular end organs
Clinical Evaluation
Clinical evaluation, including a detailed history taking and audiovestibular workup, is essential for diagnosing Meniere's disease 6. Patients should be followed closely by their ear, nose, and throat doctor, with regular clinical visits and audiovestibular tests to monitor the course of the disease and detect early changes in symptoms and/or test results.