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Testing for Meniere's disease

Timothy C. Hain, MD Page last modified: July 9, 2016

Main meniere's page is here:

Patients sometimes ask why they need to have inner ear testing with Meniere's disease.

In our clinical otoneurology practice in Chicago, we usually see at least one new patient with Meniere's disease every day. As of 2016, we had more than 500 patients in our clinical database.

A patient who fits clinical criteria for Meniere's, but who is without any previous testing, is usually asked to undergo the following procedures

Some practices (not ours) also do the glycerol test or isorbide test to rule in Meniere's. (Lee et al, 2016)

They sometimes say -- I am already dizzy - -why should I have tests done that could make me dizzier (briefly of course). Patients are also often concerned about expense of the tests, and of course, don't want to waste their time either.

There are good reasons for this process, and in this page I attempt to explain the logic. In brief, the reasons are: 1). Confirm the diagnosis 2). Rule out common alternatives 3). Follow progress of the disorder. Here is the detail:

 

Goals of testing for Menieres's disease

Confirming the diagnosis:

The diagnosis of Meniere's is a serious one, which has long term implications for deterioration in hearing and balance. Why confirm it (or rule it out ?)

Differential diagnosis

The differential diagnosis of Menieres is broad and includes perilymph fistula, recurrent labyrinthitis, migraine, congenital ear malformations of many kinds, syphilis, Lyme disease, tumors such as acoustic neuroma, multiple sclerosis, posterior fossa arachnoid cysts, and other rare entities. Symptoms similar to Meniere's (fluctuating hearing, tinnitus, vertigo) can also be caused by impending strokes in the distribution of the anterior inferior cerebellar artery (Lee and Cho, 2003). Bilaterality of hearing fluctuation suggests a vascular cause such as migraine.

Measure functional status

In Meniere's disease, hearing and balance generally progressively worsen over decades. This may lead to disability from hearing loss or imbalance or both. Monitoring hearing loss guides the intensity of treatment. Monitoring balance is less helpful, but may also be useful in situations where persons are working in dangerous environments where good balance is required.

References

Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016