Diagnostics

Meniere disease is diagnosed based on the characteristic clinical features and demonstrable low- to mid-frequency SNHL on audiometry. Specialized tests (e.g., vestibular function testing, electrocochleography) are reserved for patients with atypical symptoms or before attempting ablative therapies. Neuroimaging should be considered if central vertigo is suspected. See also “Approach to vertigo” for patients with undifferentiated acute vestibular syndrome.

• Definite Meniere disease: must include all of the following criteria

  • ≥ 2 spontaneous attacks of vertigo, each lasting 20 min to 12 hrs

  • Low to mid-frequency sensorineural hearing loss in the affected ear on audiometry

  • Fluctuating aural symptoms in the affected ear (hearing loss, tinnitus, or ear fullness)

  • Other suspected causes of vertigo excluded

• Probable Meniere disease: Patients that meet all of the above criteria but do not demonstrable hearing loss on audiometry.

• Indications

  • All patients with suspected Meniere disease

  • Before and after ablative therapy

• Modalities and characteristic findings: Subjective audiometry should always be performed in both ears.

  • Pure-tone audiometry: low- to mid-frequency sensorineural hearing loss (SNHL)

  • Speech audiometry (with word recognition score): a difference of > 15% in word recognition score between the two ears

Asymmetric fluctuating hearing loss is a characteristic feature of Meniere disease. Subjective audiometry may be normal at the time of testing because the attacks of Meniere disease are episodic.

Not routinely recommended

• Indications

  • Atypical symptoms

  • Identifying the affected ear

  • Before vestibular ablative procedures.

• Modalities and supportive findings

  • Vestibular function tests: decreased vestibular function in the affected ear [9]

  • Electrocochleography: measures the summating potential (SP) generated by cochlear hair cells and the action potential (AP) of the cochlear nerve in response to acoustic stimulation

    • Supportive findings: elevated SP/AP ratio

  • Normal vestibular function testing or electrocochleography does not rule out Meniere disease.

Imaging studies are not routinely indicated in patients with suspected Meniere disease.

• Indications

  • To rule out differential diagnosis in patients with atypical symptoms (e.g., sudden SNHL, nonfluctuating SNHL)

  • Before ablative therapies

• Preferred modality: MRI internal auditory canal and posterior fossa (without and with IV contrast)

• Supportive findings: endolymphatic space distention (endolymphatic hydrops) in the cochlea and vestibule

• See “Causes of vertigo” for other etiologies of vertigo.

  • Causes of peripheral vertigo: e.g., meniere disease, vestibular neuritis

  • Causes of central vertigo: e.g., cerebellar stroke, vestibular migraine, multiple sclerosis

• See “Differential diagnoses of vertigo” for other conditions that mimic vertigo: e.g., anxiety or panic disorder, postural hypotension, medication side effects

• Traumatic endolymphatic hydrops (due to e.g., head trauma, barotrauma)

• Otosclerosis

• Otosyphilis

Always consider vestibular migraine as a differential diagnosis of Meniere disease.