From the Guidelines
Meniere's disease is diagnosed based on specific criteria established by the American Academy of Otolaryngology-Head and Neck Surgery, requiring two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, documented low-to-medium frequency sensorineural hearing loss, and fluctuating aural symptoms. The diagnostic criteria for Meniere's disease, as outlined in the clinical practice guideline 1, include:
- Two or more spontaneous attacks of vertigo, each lasting 20 minutes to 12 hours
- Audiometrically documented fluctuating low- to midfrequency sensorineural hearing loss in the affected ear on at least one occasion
- Fluctuating aural symptoms, such as hearing loss, tinnitus, or fullness, in the affected ear The diagnosis of Meniere's disease is often challenging due to symptom overlap with other vestibular disorders, requiring careful clinical evaluation and sometimes observation over time to confirm the diagnosis 1. The goals of treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve quality of life 1.
Some key points to consider in the diagnosis of Meniere's disease include:
- The importance of documenting fluctuating hearing loss and aural symptoms, as these are key components of the diagnostic criteria
- The use of audiometry and vestibular testing to assess balance function and document hearing loss
- The potential for symptom overlap with other vestibular disorders, requiring careful clinical evaluation to confirm the diagnosis
- The importance of considering the patient's quality of life and preferences when developing a treatment plan, as outlined in the clinical practice guideline 1.
Overall, the diagnosis of Meniere's disease requires a comprehensive evaluation of the patient's symptoms, medical history, and test results, as well as careful consideration of the potential for symptom overlap with other vestibular disorders. By following the diagnostic criteria established by the American Academy of Otolaryngology-Head and Neck Surgery, clinicians can accurately diagnose and effectively manage Meniere's disease, improving patient outcomes and quality of life.
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.
- Definite Meniere's disease requires the observation of 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.
- 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.
Clinical Characteristics
The diagnosis of Meniere's disease is based on clinical criteria, including:
- 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 4.
- Duration of vertigo episodes is limited to a period between 20 minutes and 12 hours 2, 3.
- Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases 4.
Diagnostic Evaluation
The diagnostic evaluation of Meniere's disease includes:
- Audiometry 5.
- A contrast-enhanced MRI of the internal auditory canals 5.
- Exclusion of other diseases that can produce similar symptoms, such as otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors 5.