Diagnosis of Menieres Disease
The diagnosis of Menieres disease is primarily clinical, relying on a detailed account of the patient’s symptoms, medical history, and specialised hearing and balance tests. Because there is no single test that can definitively confirm the condition, the diagnosis of Menieres disease often involves ruling out other causes of vertigo and hearing loss. Early identification is essential for effective symptom management and improving the patient’s quality of life.
Clinical Evaluation and Medical History
The diagnostic process begins with a full medical history. The healthcare provider asks about how often the vertigo attacks happen, how long they last, and what they feel like. They also ask about tinnitus, ear fullness, and the degree of hearing loss. Doctors focus on how these symptoms occur together and how long each one lasts.
To confirm Menieres disease, the patient must have at least two episodes of vertigo lasting between 20 minutes and 12 hours. These must occur with hearing loss and either tinnitus or ear fullness in the affected ear. The American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) created these criteria, and they are widely used today.
Doctors also look at the pattern of symptoms. Menieres disease often starts in one ear, but it can later affect both. The symptoms tend to come and go. This changing pattern helps doctors identify the condition.
Audiometric Testing in Diagnosis of Menieres Disease
A hearing test called pure tone audiometry helps confirm sensorineural hearing loss, usually in the low to mid frequencies. This type of hearing loss is common in the early stages of Menieres disease.
Speech discrimination tests help measure how well a person understands speech at different volume levels. This test shows how much the hearing loss affects daily life and helps separate Menieres disease from other hearing problems.
Repeating audiograms over time can show hearing changes, which is a key sign of this disease. As the condition progresses, the hearing loss usually becomes worse and more permanent.
Vestibular Function Tests
Doctors also check balance and inner ear function using several tests:
• Videonystagmography (VNG): Measures eye movements in response to visual or head movements to check inner ear function.
• Rotational Chair Testing: Used when VNG is unclear. It measures how the eyes and inner ear work together during rotation.
• Vestibular Evoked Myogenic Potentials (VEMP): Checks parts of the ear affected by Menieres disease.
• Posturography: Measures how the body maintains balance in different situations.
These tests can confirm balance problems, but results are often normal between attacks. This means timing is important for accurate results.
Electrocochleography (ECoG)
Electrocochleography measures how the inner ear reacts to sound. A high SP/AP ratio may indicate fluid buildup in the ear, known as endolymphatic hydrops — a main cause of Menieres disease.
This test can support the diagnosis, but it is not always necessary. Its accuracy varies, and doctors often rely on it along with other findings.
Imaging Studies
MRI scans help rule out other causes of vertigo and hearing loss, such as acoustic neuroma, multiple sclerosis, or stroke. An MRI with contrast can show the inner ear canal and nearby brain areas. In some advanced clinics, special MRI techniques can even show fluid buildup, but this is not standard yet.
Blood and Laboratory Tests
There are no specific blood tests for Menieres disease. However, doctors may order lab tests to rule out other conditions with similar symptoms. These include:
• Thyroid function tests
• Blood glucose levels
• Autoimmune markers such as ANA or ESR
• Syphilis tests like VDRL or FTA-ABS
These are most helpful if both ears are affected or if symptoms are unusual.
Differential Diagnosis of Menieres Disease
Doctors must rule out other disorders that look similar. These include:
• Benign Paroxysmal Positional Vertigo (BPPV): Short vertigo spells triggered by head movement.
• Vestibular Migraine: Causes repeated vertigo with headache or vision problems.
• Labyrinthitis or Vestibular Neuritis: Severe sudden vertigo without hearing loss.
• Acoustic Neuroma: A slow-growing tumour causing hearing loss and balance issues.
• Otosclerosis or Autoimmune Inner Ear Disease (AIED): Progressive hearing loss with tinnitus.
Accurate diagnosis avoids wrong treatments and helps guide proper care.
Diagnostic Categories
The AAO-HNS classifies Menieres disease into four stages based on evidence:
- Possible: Some symptoms but incomplete data.
- Probable: One vertigo episode with hearing symptoms.
- Definite: Two or more vertigo attacks with hearing loss and tinnitus or ear fullness.
- Certain: Confirmed by tissue study (rarely, after death).
Most people fall into the “definite” category after more data is collected over time.
Role of Early Diagnosis in Menieres Disease
Early diagnosis makes a major difference. It helps manage symptoms and may prevent lasting hearing damage. Detecting the disease early allows lifestyle and medical changes to start sooner. These can reduce how often and how severe vertigo attacks are.
It also helps with emotional support. People learn how to live better with this long-term condition through guidance, hearing aids, and balance therapy.
