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Meniere disease

Last reviewed: 2 Apr 2025
Last updated: 06 Feb 2024

Summary

Definition

History and exam

Key diagnostic factors

  • vertigo
  • hearing loss
  • tinnitus
  • aural fullness
  • drop attacks
Full details

Other diagnostic factors

  • positive Romberg test
  • Fukuda stepping test
  • bilateral symptoms
  • nystagmus
  • tandem walk
Full details

Risk factors

  • recent viral infection
  • genetic predisposition
  • autoimmune disease
  • increasing age
Full details

Diagnostic tests

1st tests to order

  • pure-tone air and bone conduction with masking
  • speech audiometry
  • tympanometry/immittance/stapedial reflex levels
  • otoacoustic emissions (OAE)
Full details

Tests 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
  • antinuclear antibody
  • antineutrophil cytoplasmic antibody
  • rheumatoid factor
Full details

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 declares that she has no competing interests.

Acknowledgements

Dr Ghossaini would like to gratefully acknowledge the late Professor Maurice H. Miller, a previous contributor to this topic. MHM declared that he had no competing interests.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Goebel JA. 2015 Equilibrium Committee amendment to the 1995 AAO-HNS guidelines for the definition of Ménière's disease. Otolaryngol Head Neck Surg. 2016 Mar;154(3):403-4. Abstract

Basura GJ, Adams ME, Monfared A, et al. Clinical practice guideline: Ménière's disease. Otolaryngol Head Neck Surg. 2020 Apr;162(suppl 2):S1-55.Full text  Abstract

Lopez-Escamez JA, Carey J, Chung WH, et al; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Menière's disease. J Vestib Res. 2015;25(1):1-7.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: hearing loss and/or vertigo. 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Meniere 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 information

    Tinnitus

    Meniere disease

    More Patient information
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