Meniere's disease

Last reviewed: 24 Apr 2022
Last updated: 18 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • vertigo
  • hearing loss
  • tinnitus
  • aural fullness
  • drop attacks
More key diagnostic factors

Other diagnostic factors

  • positive Romberg's test
  • Fukuda's stepping test
  • bilateral symptoms
  • nystagmus
  • tandem walk
Other diagnostic factors

Risk factors

  • recent viral infection
  • genetic predisposition
  • autoimmune disease
More risk factors

Diagnostic investigations

1st investigations to order

  • pure-tone air and bone conduction with masking
  • speech audiometry
  • tympanometry/immittance/stapedial reflex levels
  • oto-acoustic emissions (OAE)
More 1st investigations to order

Investigations to consider

  • electrocochleography
  • electronystagmography
  • 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
More investigations to consider

Emerging tests

  • 3-dimensional MRI

Treatment algorithm

ACUTE

all patients

ONGOING

persistent hearing loss

failure of medical and intratympanic therapies; hearing adequate

failure of medical and intratympanic therapies; hearing severely impaired

Contributors

Authors

Soha N. Ghossaini, MD, FACS
Soha N. Ghossaini

Otology-Neurotology

Ear Nose and Throat Associates of New York

New York

NY

Disclosures

SNG has received sponsorship for BONEBRIDGE surgical training by MED-EL 2019.

Acknowledgements

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.

Peer reviewers

Steven D. Rauch, MD

Associate Professor of Otology and Laryngology

Harvard Medical School

Boston

MA

Disclosures

SDR declares that he has no competing interests.

Christopher J. Linstrom, MD

Professor

Otolaryngology/Head and Neck Surgery

The New York Eye and Ear Infirmary

Surgeon Director

New York

NY

Disclosures

CJL declares that he has no competing interests.

Peter Rea, MA, BM BCh, FRCS(ORL-HNS)

Consultant ENT Surgeon

Leicester Royal Infirmary

Leicester

UK

Disclosures

PR declares that he has no competing interests.

Doris Eva Bamiou, MD, MSc, PhD

Clinical Senior Lecturer & Consultant in Audiovestibular Medicine

Ear Institute

University College London

London

UK

Disclosures

DEB declares that she has no competing interests.

  • Meniere's disease images
  • Differentials

    • Acoustic neuroma
    • Vestibular migraine (also called migraine-associated dizziness and migraine-associated vertigo)
    • Vestibular neuronitis
    More Differentials
  • Guidelines

    • Clinical practice guideline: Ménière's disease
    • Clinical practice guideline: sudden hearing loss (update)
    More Guidelines
  • Patient leaflets

    Tinnitus

    Meniere's disease

    More Patient leaflets
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