A couple of weeks back, I did a short post discussing that many patients diagnosed with Meniere’s disease may be misdiagnosed. I received a comment from a reader asking, “is there now a definitive way to diagnose Meniere’s?” Well, sort of.
Meniere’s disease is diagnosed by recognizing a pattern of symptoms and a constellation of clinical signs. There is no definitive test for Meniere’s, but rather a pattern of audiometric and vestibular test findings that either fits well, fits somewhat, or doesn’t fit the profile of Meniere’s disease. Using vestibular function tests to diagnose Meniere’s disease is a tricky proposition.
An international panel, representing specialty societies around the world, updated and published a consensus paper in 2015 with criteria for “Definite Meniere’s disease” and “Probable Meniere’s disease.” The criteria is summarized below in an excerpt from Dr. Tim Hain’s webpage.
Definite Meniere’s disease diagnosis:
- Two or more spontaneous episodes of vertigo 20 minutes and 12 hours
- low to medium frequency sensorineural hearing loss. Thresholds must be at least 30 dB HL worse in the affected ear at two contiguous frequencies below 2000 Hz.
- fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ears. Must occur within 24 hours of the vertigo episode.
- Not better accounted for by another vestibular diagnosis.
Probable Meniere’s disease:
- episodic vestibular symptoms (vertigo or dizziness) 20 minutes to 24 hours associated with
- fluctuating aural symptoms (hearing, tinnitus or fullness)
- Not better accounted for by another vestibular diagnosis”
When you look at the difference between the “definite” and “probable” criteria, you see that fluctuating low frequency sensorineural hearing loss is critical to establishing a confident diagnosis.
One final comment, this criteria discussed active Meniere’s disease. For many patients with Meniere’s, the symptoms described are active for a few years, then the episodic vertigo and fluctuating hearing levels stabilize. The patient is typically left with permanent hearing loss and stable dysfunction of the labyrinth on the affected side. This is commonly referred to as “end stage Meniere’s” and presents a different set of symptoms and treatment options.