GPAtlas🧭 When to suspect
Suspect Ménière's disease in an adult with the characteristic triad of recurrent spontaneous vertigo, fluctuating sensorineural hearing loss, and tinnitus, classically with a sense of aural fullness or pressure in the affected ear. Attacks arise without warning, typically last 20 minutes to 12 hours, and are usually accompanied by nausea and vomiting; early in the disease the patient is often entirely well between attacks.
It is an idiopathic disorder associated with endolymphatic hydrops, usually unilateral at onset, presenting most often between the third and seventh decades. There is no single confirmatory test, so this is a clinical diagnosis built on the pattern of attacks over time and supported by audiometry – and it is frequently over-diagnosed, with vestibular migraine the commonest mimic.
The two practical skills in primary care are to recognise the pattern against its mimics, and to exclude a dangerous cause of acute vertigo – notably posterior-circulation stroke – before applying the label.
| Definite Ménière's disease | Probable Ménière's disease |
|---|---|
| ≥ 2 spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours | ≥ 2 episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours |
| Audiometrically documented low-to-medium frequency sensorineural hearing loss in the affected ear, on ≥ 1 occasion before, during or after an episode | Fluctuating aural symptoms (hearing, tinnitus or fullness) in the affected ear |
| Fluctuating aural symptoms (hearing, tinnitus or fullness) in the affected ear | Not better accounted for by another vestibular diagnosis |
| Not better accounted for by another vestibular diagnosis |
|
⚠️ Common pitfall Labelling every patient with vertigo and ear symptoms as Ménière's. Vestibular migraine is far more common and is the classic mimic – but it tends to feature headache, photophobia or visual aura, vertigo of any duration, and no progressive low-frequency hearing loss. Without documented fluctuating low-to-medium frequency sensorineural hearing loss in one ear, the diagnosis is usually something else. |
Source: Bárány Society diagnostic criteria · American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
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