Clinical diagnosis

Diagnosis

Meniere's disease is a clinical diagnosis. Patients usually present with episodic dizziness.

• acute episodes of vertigo should be differentiated from non-rotatory dizziness
  • ask the question "did you just feel lightheaded or did you see the world spin around as though you just got off a playground roundabout?
    
    
    • no - then could be presyncope, light-headedness, and disequilibrium in elderly people
      
      
    • yes - rule out "red flags" suggesting brainstem stroke or other central signs, do confirmatory test to rule out other common causes of vertigo
      
      
      • Hallpike manoeuvre - for benign positional vertigo, head thrust test - for acute vestibular neuritis
        
        
      • if both are negative consider
        • vestibular migraine - if vertigo plus migraine is recurrent
        • Meniere's disease - transient unilateral hearing loss or tinnitus, and previous episodes of dizziness

Note - complete audiological evaluation is important for the diagnosis of Meniere's and includes pure-tone air and bone conduction with appropriate use of masking, speech audiometry, tympanometry, and oto-acoustic emissions.

Reference

1. 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.