From the Guidelines
Diagnosis of Ménière’s Disease
Ménière’s disease is diagnosed in patients presenting with 2 or more episodes of vertigo lasting 20 minutes to 12 hours and fluctuating or nonfluctuating sensorineural hearing loss, tinnitus, or pressure in the affected ear 1.
Key Diagnostic Criteria
- Vertigo: 2 or more episodes lasting 20 minutes to 12 hours (definite) or up to 24 hours (probable)
- Hearing Loss: fluctuating or nonfluctuating sensorineural hearing loss
- Other Symptoms: tinnitus, or pressure in the affected ear
Diagnostic Approach
The diagnosis is based on a thorough otologic history and physical examination to evaluate for other causes of vertigo/dizziness, such as neurologic, otologic, or infectious causes 1.
Audiometric Testing
Audiometric testing is recommended to assess patients for the diagnosis of Ménière’s disease, with a strong recommendation based on systematic reviews of cross-sectional studies 1.
Vestibular or Electrophysiologic Testing
Vestibular function testing or electrocochleography (ECochG) is not routinely recommended to establish the diagnosis of Ménière’s disease, based on systematic reviews of cross-sectional studies and observational ECochG studies 1.
Differential Diagnosis
A thorough evaluation should consider other causes of vertigo/dizziness, including benign paroxysmal positional vertigo, vestibular migraine, labyrinthitis, and vestibular neuritis, among others 1.
Clinical Education
Patients should be clinically educated to clearly define their symptoms, with a focus on vertigo attacks, onset, duration, and concurrent otologic symptoms 1.
From the Research
Diagnosis of Ménière's Disease
The diagnosis of Ménière's disease is based on clinical criteria and can be categorized into two types: definite and probable Ménière's disease. The key symptoms and diagnostic criteria are:
- 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
- Duration of vertigo episodes limited to a period between 20 minutes and 12 hours for definite Ménière's disease 2, 3
- Probable Ménière'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
- Additional symptoms such as headache and bilateral involvement may also be present 4, 5
Diagnostic Considerations
A careful history and complete physical examination are necessary for diagnosis, as the symptoms of Ménière's disease may not develop or occur simultaneously 5. Audiologic and vestibular assessment is recommended to monitor the clinical course 4. The diagnosis of Ménière's disease should be differentiated from other causes of dizziness, such as vestibular migraine, which may present with similar symptoms 6.
Classification and Symptoms
The classification of Ménière's disease includes two categories: definite and probable Ménière's disease. The symptoms of Ménière's disease include:
- Episodic vertigo syndrome
- Low- to medium-frequency sensorineural hearing loss
- Fluctuating aural symptoms (hearing, tinnitus, and/or fullness)
- Headache
- Bilateral involvement in 25-40% of cases 4