From the Guidelines
Meniere's disease should be 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, when these symptoms are not better accounted for by another disorder. This diagnosis is based on the clinical practice guideline for Meniere's disease, which recommends diagnosing definite or probable Meniere's disease in patients with these symptoms 1. The diagnosis of Meniere's disease is primarily clinical, as there is no single definitive test for the condition.
Key Diagnostic Criteria
- Two or more episodes of vertigo lasting 20 minutes to 12 hours
- Fluctuating or nonfluctuating sensorineural hearing loss
- Tinnitus or pressure in the affected ear
- Exclusion of other possible causes
Diagnostic Tests
- Audiometric testing to evaluate hearing loss
- Videonystagmography (VNG) or electronystagmography (ENG) to evaluate vestibular function
- Electrocochleography (ECoG) to measure electrical responses of the cochlea and auditory nerve
- MRI to rule out other conditions like acoustic neuroma
- Glycerol test to assess endolymphatic hydrops
- Video head impulse testing (vHIT) and vestibular evoked myogenic potentials (VEMP) to evaluate vestibular function
The clinical practice guideline for Meniere's disease provides a comprehensive approach to diagnosis and management, emphasizing the importance of accurate diagnosis and proper treatment to improve patient quality of life 1. By following these guidelines, healthcare providers can effectively diagnose and manage Meniere's disease, reducing the risk of misdiagnosis and improving patient outcomes.
From the Research
Diagnosis of Meniere's Disease
The diagnosis of Meniere's disease is based on clinical criteria and requires the observation of an 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.
- Key symptoms include:
- Episodic vertigo
- Fluctuating hearing loss
- Tinnitus
- Aural fullness
- A careful history and a complete physical examination are necessary for diagnosis, as these symptoms may or may not develop or occur simultaneously 3.
- Audiologic and vestibular assessment is recommended to monitor the clinical course 2.
- Laboratory tests are useful in tailoring and following up patients 4.
Diagnostic Challenges
- Meniere's disease may be the underlying cause of dizziness, which is a common presenting complaint 3.
- The disease is differentiated from other causes of dizziness by its classic constellation of four symptoms: dizziness characterized as episodic spinning or whirling vertigo, fluctuating low-frequency sensorineural hearing loss, tinnitus, and a sensation of fullness in the ear 3.
- Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases 2.