ear, nose, and throat disorders
Meniere Disease
Diagnosis of Meniere Disease
Clinical evaluation Audiogram and gadolinium-enhanced MRI to rule out other causes The diagnosis of Meniere disease is made clinically. The simultaneous combination of fluctuating low-frequency sensorineural hearing loss, episodic vertigo, ipsilateral fluctuating aural fullness, and tinnitus is characteristic. Similar symptoms can result from vestibular migraine, Vestibular Neuronitis , viral labyrinthitis, a cerebellopontine angle tumor (eg, Between attacks, the examination may be entirely normal. But during an acute attack, the patient has Nystagmus and falls to the affected side. Also, in long-standing or refractory cases with associated labyrinthine hypofunction, the Fukuda stepping test (marching in place with eyes closed, previously known as the Unterberger test) causes the patient to turn toward the affected ear, consistent with a unilateral labyrinthine lesion. TheHalmagyi head thrust maneuver, or head impulse test, is another technique that is used to check for unilateral labyrinthine dysfunction. In the Halmagyi maneuver, the examiner has the patient visually fixate on a target straight ahead (eg, the examiner's nose). Then while observing the patient's eyes, the examiner rapidly rotates the patient's head 15 to 30° to one sides. When the head is rotated to one side, vestibular function on that side is normal if the patient's eyes remain fixated on the target. When vestibular function is impaired, the vestibulo-ocular reflex is absent and the patient's eyes do not remain fixated on the target but instead transiently follow the head rotation and then quickly and voluntarily return back to the target (called delayed catch-up saccades). and an MRI (with gadolinium enhancement) of the central nervous system with attention to the internal auditory canals to exclude other causes. Audiogram typically shows a low-frequency sensorineural hearing loss in the affected ear that fluctuates between tests. The Physical examination and the 