Ménière's Disease Diagnosis and Management

Definition and Diagnostic Criteria

The American Academy of Otolaryngology-Head and Neck Surgery defines Ménière's disease as an inner ear disorder characterized by spontaneous vertigo attacks lasting 20 minutes to 12 hours, with documented low- to mid-frequency sensorineural hearing loss and fluctuating aural symptoms including tinnitus and ear fullness 1, 2
Definite Ménière's disease is diagnosed when there are two or more spontaneous attacks of vertigo, each lasting 20 minutes to 12 hours, audiometrically documented fluctuating low- to mid-frequency sensorineural hearing loss, and fluctuating aural symptoms in the affected ear 2
Probable Ménière's disease is diagnosed when there are two or more episodes of vertigo lasting up to 24 hours, fluctuating or non-fluctuating sensorineural hearing loss, tinnitus, or pressure in the affected ear, and symptoms not better accounted for by another disorder 3

The underlying etiology of Ménière's disease is associated with inner ear fluid (endolymph) volume increases, according to the American Academy of Otolaryngology-Head and Neck Surgery 2

Vertigo in Ménière's disease is characterized as a sensation of self-motion or movement of the environment when neither is occurring, as defined by the American Academy of Otolaryngology-Head and Neck Surgery 2
Hearing loss in Ménière's disease often fluctuates from low- to mid-frequency but over time may involve all frequencies, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
Tinnitus is a common symptom of Ménière's disease, characterized as ringing, buzzing, or other noises in the ear when there is nothing causing the noise, as defined by the American Academy of Otolaryngology-Head and Neck Surgery 4
Aural fullness is a sensation of ear feeling full or plugged, as defined by the American Academy of Otolaryngology-Head and Neck Surgery 4

An audiogram is essential for diagnosing Ménière's disease, including pure tone thresholds and measures of speech recognition, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 3
MRI of the internal auditory canal and posterior fossa may be offered in patients with nonfluctuating sensorineural hearing loss, tinnitus, or pressure when symptoms are not better accounted for by another disorder, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3, 5

The American Heart Association recommends a low sodium diet (less than 1500 mg daily) as a conservative measure for managing Ménière's disease 6
Vestibular suppressants should be offered for a limited course to manage acute vertigo attacks, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3
Diuretics may help reduce symptoms by decreasing fluid retention, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6
Intratympanic steroids may be offered to patients with active Ménière's disease not responsive to conservative measures, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3
Intratympanic gentamicin should be offered to patients with active Ménière's disease not responsive to nonablative therapy, with caution due to its ablative effects on vestibular function, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3

Patients with Ménière's disease should be educated about the natural history, measures for symptom control, treatment options, and outcomes, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3
Patients should be informed that Ménière's disease is an adult-onset disorder, has unpredictable vertigo attacks and fluctuations in hearing, tinnitus, and ear fullness, and may result in worsening hearing over time, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6