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Ménière’s Disease: A Lifelong Merry-Go-Round

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DIAGNOSIS
Establishing the diagnosis of Ménière’s disease can be difficult and time-consuming because the symptoms of the disorder are nonspecific and variable. Ménière’s disease is a clinical diagnosis, and thus the clinician must conduct a thorough physical exam and elicit a very specific history, including a detailed description of vertigo incidents and associated symptoms. Often, the greatest challenge is encouraging patients to articulate the details of their episodes. Patients may not keep a record of the variations of episodes, nor do they always know what information is needed. Thus, the provider needs to elicit specific information by asking questions regarding frequency and duration of episodes, as well as fluctuation of hearing loss, nausea, and tinnitus. Symptoms associated with vertigo during a Ménière’s episode may include nausea, vomiting, gait imbalance, and tinnitus. Most vertigo attacks from Ménière’s disease occur in clusters, but they may also occur sporadically.6

An additional challenge for clinicians is that other potential diagnoses related to vertigo must be excluded before the diagnosis of Ménière’s disease can be made. Also, it is important to note that specialists may differentiate Ménière’s disease, an idiopathic condition, from Ménière’s syndrome, which results from known causes of damage to the inner ear. In the literature, however, this distinction in terminology is not always clear.7

Specific diagnostic criteria for Ménière’s disease, defined in 1995 by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), remain the gold standard for diagnosis.3 A “definite” diagnosis of Ménière’s disease is based on:

• A history of two or more episodes of spontaneous vertigo lasting 20 minutes or longer,

• Hearing loss documented by audiometry at least once,

• Presence of tinnitus, and/or

• A sensation of aural fullness.2,6,7

The AAO-HNS diagnostic criteria also define categories of “probable” and “possible” Ménière’s disease based on the frequency of vertigo episodes or the presence of a combination of associated symptoms (see Table 1).3,7

Patients with Ménière’s disease may experience different patterns of symptoms. “Auditory dominant” Ménière’s disease produces more hearing loss changes than vertigo, while “vestibular dominant” causes frequent episodes of severe vertigo and less severe hearing changes. A “mixed” pattern of Ménière’s disease manifests with both hearing fluctuations and vertigo.5

Unilateral symptoms are most common; however, bilateral disorder occurs in approximately 25% of patients, either at onset or with changing symptomatology over time.5,8,9

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