Meniere's disease is an episodic auditory and vestibular disease characterised by sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear. Earlier in the disease process, all symptoms may not be present.
The cause is unknown, but results in an over-production or impaired absorption of endolymph in the inner ear.
Diagnosis is made on clinical history and detailed audiological tests; other investigations may be required to exclude other causes.
Dietary changes and diuretics may control symptoms in early stages of the disease; specific medical therapies for vertigo control can be tried if required.
If symptoms persist despite maximal medical therapy, several surgical interventions are available.
Meniere's disease (MD) or Meniere syndrome is an auditory disease characterised by an episodic sudden onset of vertigo, low-frequency hearing loss (in the early stages of the disorder), low-frequency roaring tinnitus, and sensation of fullness in the affected ear. Usually the terms are used interchangeably, but MD is commonly used if it is idiopathic (i.e., without known cause) and Meniere syndrome if it is secondary to a number of known inner-ear disorders. It is also called endolymphatic hydrops, because of the described pathological state observed on post mortem histological sectioning. It is unclear whether this is a cause of symptoms or a result of the pathological process.
History and exam
Key diagnostic factors
- presence of risk factors
- hearing loss
- aural fullness
- drop attacks
Other diagnostic factors
- positive Romberg's test
- Fukuda's stepping test
- bilateral symptoms
- tandem walk
- recent viral infection
- genetic predisposition
- autoimmune disease
1st investigations to order
- pure-tone air and bone conduction with masking
- speech audiometry
- tympanometry/immittance/stapedial reflex levels
- oto-acoustic emissions (OAE)
Investigations to consider
- rotary chair test
- vestibular-evoked myogenic potential (VEMP)
- MRI of internal auditory canals
- thyroid function tests
- Lyme disease and syphilis serology
- anti-nuclear antibody
- anti-neutrophil cytoplasmic antibody
- rheumatoid factor
- 3-dimensional MRI
persistent hearing loss
failure of medical and intratympanic therapies; hearing adequate
failure of medical and intratympanic therapies; hearing severely impaired
Soha N. Ghossaini, MD, FACS
Ear Nose and Throat Associates of New York
SNG has received sponsorship for BONEBRIDGE surgical training by MED-EL 2019.
Dr Ghossaini would like to gratefully acknowledge Professor Maurice H. Miller, a previous contributor to this topic. MHM declared that he had no competing interests. Unfortunately we have since been made aware that Professor Miller has passed away.
Steven D. Rauch, MD
Associate Professor of Otology and Laryngology
Harvard Medical School
SDR declares that he has no competing interests.
Christopher J. Linstrom, MD
Otolaryngology/Head and Neck Surgery
The New York Eye and Ear Infirmary
CJL declares that he has no competing interests.
Peter Rea, MA, BM BCh, FRCS(ORL-HNS)
Consultant ENT Surgeon
Leicester Royal Infirmary
PR declares that he has no competing interests.
Doris Eva Bamiou, MD, MSc, PhD
Clinical Senior Lecturer & Consultant in Audiovestibular Medicine
University College London
DEB declares that she has no competing interests.
- Acoustic neuroma
- Vestibular migraine (also called migraine-associated dizziness and migraine-associated vertigo)
- Vestibular neuronitis
- Clinical practice guideline: Ménière's disease
- Clinical practice guideline: sudden hearing loss (update)
Meniere's diseaseMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer