Ménière's disease affects the inner ear and is characterized by attacks of vertigo, tinnitus, hearing loss and feelings of pressure within the ear. These attacks are sudden, sever and may be debilitating.
There is no single test for Ménière's disease. The symptoms alone can make diagnosis difficult since they also occur in other disease conditions of the ear.
Diagnosis of this condition is based on clinical findings and features, results of hearing tests or audiometry tests and also be ruling out other conditions affecting the inner ear.
Steps of diagnosis of the condition include detailed history of symptoms, physical examination and so forth. (1-6)
Detailed history of symptoms
A detailed history of symptoms is taken. This includes regular and periodic unpredictable attacks of vertigo, dizziness with nausea, vomiting, diarrhoea and palpitations, hearing loss, tinnitus and feeling of fullness of the ear(s).
A general physical examination is performed next. This includes looking at the heart rate and blood pressure. A low blood pressure may also lead to dizziness and vertigo.
Anemia, abnormalities of heart rhythm (arrhythmias) are also causes for dizziness and these should be ruled out.
The ears and the inner ears are examined using a special light. Presence of wax impaction is noted. Ménière's disease is usually diagnosed by an Otolaryngologist (ENT specialist).
The specialist examines the cranial nerves and eyes for jerky movements (nystagmus). He or she also checks for balance, gait and coordination using the Romber’s test and the finger nose test.
Cervical spine is examined for vertigo associated with cervical spondylosis and neck pain.
The Hallpike manoeuvre
The Hallpike manoeuvre is used to diagnose vetigo due to Benign paroxysmasl positional vertigo (BPPV).
Criteria for diagnosis of Ménière's disease
The criteria for diagnosis includes:
- Vertigo seen at least two spontaneous episodes lasting at least 20 minutes in a one attack of Ménière's disease
- Tinnitus and or feeling of fullness in the ear
- Loss of hearing confirmed by audiometry testing
Hearing loss caused by the disease is tested using an audiometry test. An audiometry test is performed with a machine that produces sounds of different volume and pitch. Patient is asked to listen to the sounds through headphones and signal when they hear the sounds by pressing a button or raising their hand.
In early stages of Ménière's disease there is usually no loss of hearing. As the disease progresses there may be increased and more irreversible loss of hearing.
Otoacoustic emission test
An otoacoustic emission test is prescribed to check for the degree of damage to the hearing cells of the inner ear’s organ called the cochlea.
An electrocochleography is performed to measure the electrical force generated in the cochlea of the inner ear and the nerve in response to stimulation by sound. This also detects the exact cause of hearing loss.
Ruling out other diseases
Other diseases that need to be ruled out include:
- acoustic neuroma
- ear infections (otitis media)
- ear wax
- toxicity due to drugs and medications
- brain tumors
- thyroid under activity
- syphilis etc.
Blood tests are performed to check for anemia, thyroid function, syphilis screen, blood glucose, kidney function, cholesterol etc.
Video nystagmography or electronystagmographic is performed to check the jerky movements of the eyes or nystagmus that is associated with Ménière's disease.
Another test is the Brainstem auditory evoked potential test to check for electrical activities of the lower part of the brain that regulates posture and balance. Computerized Dynamic Posturography may also be performed to evaluate the balance system.
MRI brain scan
An MRI brain scan is advised to check for tumors and other diseases that mimic this condition. X rays of the jaw bones and the sinuses are also recommended to detect growths or tumors that may be causing the symptoms.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)