Diagnosis of Meniere's Disease

For a diagnosis of Meniere’s disease to be made, patients must first see an appropriate health care professional, such as a primary care physician (family physician, internist, pediatrician, or obstetrician/gynecologist), a physician extender (such as a physician’s assistant or nurse practitioner), or a hearing professional otolaryngologist, audiologist or hearing aid fitter), and mention their symptoms. Different health care professionals have different levels of expertise when it comes to hearing disorders, so it may not be unusual for a primary care physician to refer patients to a specialist (such as a neurologist, or otolaryngologist [ENT doctor]).

At the visit, the doctor (for simplicity’s sake, we will refer to all ear professionals as "doctors") will ask patients a lot of questions (the medical history) about their problem and symptoms, their general health, what has happened to them in the past, medical information about the people in their family. (Has anyone else ever had hearing problems in your family?), and other specific questions. Important questions are:

• When did this problem start?
  
• Is there anything that happened to you just before this problem started?
  
• What are the symptoms that are bothering you? How bad are they?
  
• When do they begin?
  
• Does anything seem to trigger these attacks? Does anything help relieve the symptoms?

Next, the doctor will do a physical examination, looking at the ears, as well as many other parts of the body. He may listen with a stethoscope to the neck and even the head, as well as the heart and lungs, to see if he can hear murmurs and sounds of flowing blood that may be causing the tinnitus. He may examine the eyes, looking for damage to the nerves or for tremors of the eyes (called nystagmus) that may be a clue to balance disorders. Special lenses (Fresnel lenses) may be placed over the eyes to make the world look blurry, and help the doctor look for small amounts of nystagmus. He may do simple hearing tests with a tuning fork, or balance tests (such as standing with the eyes shut, with the heel of one foot just in front of the toe of the other [like walking on a tightrope], the so called "sharpened Romberg," [Derebery M J. The diagnosis and treatment of dizziness. Med Clin North Am. 1999; 83:163-177.]which is a good test for normal balance function). The Dix-Hallpike maneuver may be done, in which a person rapidly lies down and hangs the head over the edge of the examination table, then turns the neck to see if dizziness or nystagmus can be produced.

Most often, patients will be sent for special hearing tests, usually performed by an audiologist. These will include an audiogram (to see how well the ear can hear different pitched sounds), a tympanometry (to check for middle ear and eustachian tube problems), and speech audiometry to see how well one can hear and recognize spoken words at different levels of loudness. Often a special balance test, the electronystagmogram (ENG), will be done, in which warm or cold fluids are placed into the ear canal to look for nystagmus with electrical wires taped to the head and around the eyes. Another test often used is the auditory evoked potentials (AEP, also known as BAEP, BAER, SLAEP, SLAER) test, in which headphones are used to play clicks into the ear and wires on the neck and head are used to record the brainwaves produced by hearing those clicks. Other tests may be done to take special pictures of the ears and head, such as CT scans, MRI scans, or special skull radiographs (X-rays). Blood tests may be done to make sure there is no infection or metabolic disorder that could be causing the symptoms. Of course, other more unusual tests may be ordered if the doctor feels that they may help define the exact cause of the symptoms.

Once all the test results are back, the doctor may find that another disorder is causing the symtoms. If so, there may be special treatments, depending on what disease or disorder is the cause. If no other cause is found, then the patient most likely has Meniere’s disease; patients can check with the American Academy of Otolaryngology’s - Diagnostic Criteria (Table 2) to see if they fit the definition, based on their pattern of symptoms, proven abnormalities on testing, and the lack of any other explanation for that pattern of symptoms.

If the diagnosis of Meniere’s is confirmed, most likely the doctor will prescribe treatment; some of the treatments for mimics of Meniere’s disease are listed in the next section, whereas treatments for Meniere’s are listed in the section after that.

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