CAUTION: It is not possible to self-diagnose
Meniere's Disease. Meniere's Disease is *not* defined by its
symptoms. There are many disorders that have the same symptoms
as Meniere's Disease. A differential diagnosis with diagnostic
tests is required. For a diagnosis, you *must* see a licensed
and qualified medical professional.
The etiology (cause) of Meniere's
Disease is unknown. (See our Cause
Page.)
It is not possible to diagnose
Meniere's Disease based upon one's symptoms.
It is not possible to say whether
one's symptoms "sound like" Meniere's Disease.
It is not possible to "suspect"
that one has Meniere's Disease.
The symptoms of Meniere's Disease are
also the symptoms of many other diseases and conditions.
These other diseases and conditions
are sometimes said to be "mimics" (see below) of Meniere's Disease.
(Although Meniere's Disease could equally be said to be a "mimic" of
the other diseases and conditions.)
There is no specific diagnostic test
that can definitively identify Meniere's Disease.
Therefore, a "differential diagnosis"
must be conducted to differentiate among the possibilities and
diagnose the patient. This is a matter of ascertaining the
symptoms and then, one by one, testing for and thereby confirming or
eliminating (excluding) all possible diseases and conditions that may
result in those symptoms. Since there is no specific diagnostic test
that can definitively identify Meniere's Disease, when all other
possible diseases and conditions have been excluded, the symptoms are
diagnosed as "Meniere's Disease."
One protocol for a differential diagnosis of the
symptoms that may or may not be Meniere's Disease. Keep in mind
that there are many such protocols.
The results of a survey asking doctors how they
diagnose and how they treat Meniere's Disease have been published:
Trends in the Diagnosis and the Management of
Meniere's Disease: Results of a Survey, by
H.H. Kim, R.J. Wiet, and R.A. Battista.
Otolaryngol Head
Neck Surg. 2005 May;132(5):722-6.
When no other diagnosis can be determined, the
patient is said to have "Meniere's Disease." This is tantamount
to saying "we know what your symptoms are, but we don't know what is
causing them." In this sense, "Meniere's Disease" is the
"default diagnosis" when no other diagnosis seems to apply.
There are many definitions of
Meniere's Disease.
"Classic" Meniere's Disease (four
symptoms).
Here is
our lay and inexpert definition:
"Classic" (typical) Meniere's Disease is the term given to the
condition having the following four symptoms, after thorough testing
has determined no other cause:
Episodic,
fluctuating hearing loss.
Episodic,
fluctuating rotational vertigo (a form of dizziness).
Episodic,
fluctuating tinnitus (a sound heard when there is no sound).
Episodic,
fluctuating aural fullness (a sense of air pressure in the middle ear,
as if descending in an airplane; however, it is *not* actual air
pressure in the middle ear; Meniere's Disease does not affect the
middle ear).
This is the most commonly-used
authoritative definition of "classic" (four symptoms) Meniere's Disease in the U.S.:
There are other definitions of
Meniere's Disease, and each doctor may use a different definition.
Each doctor may have his or her own
definition.
Our lay and
inexpert speculation.
Perhaps there are ten
(or more or fewer) currently unknown diseases that each have the same
symptoms as what we now call "Meniere's Disease," and we each have one
(or perhaps two or three) of the ten (or more or fewer) of the
currently unknown diseases. *IF* this is true, then ten patients could
be diagnosed with "Meniere's Disease," yet each one could have a
different disease, and each one could respond differently to various
treatments.
"Atypical" Meniere's Disease (three
symptoms).
For a discussion of "atypical"
Meniere's Disease, click here.
Diagnostic tests.
Remember, there is no specific test
for Meniere's Disease. Therefore, the purpose of diagnostic
testing is to determine whether there is any other "testable" disease
that is causing the symptoms. If all testing for other diseases
and conditions that can cause the same symptoms fails, the patient is
said to have "Meniere's Disease."
Lab Tests Online:
source of information on clinical laboratory testing.
Audiogram (basic hearing test).
The purpose of the audiogram is to measure hearing to determine
whether there is any hearing loss, and the frequencies at which the
hearing loss occurs. To knowledgeable professionals, this apparently
"simple" test can be an important tool for diagnosis as well as a
measurement technique. Remember, that in Meniere's Disease, hearing
loss fluctuates; therefore, comparison of one set of test results to
another can be deceptive unless properly interpreted.
Differential Diagnosis of Sensorineural Hearing Loss, Dr. M.M. Carr, University of Toronto. Meniere's
Disease causes sensorineural hearing loss rather than conductive
hearing loss. Sensorineural hearing loss is a loss of hearing
due to impaired transmission across the auditory branch of the 8th
cranial nerve. Conductive hearing loss is caused by a problem
with bone conduction, such as impairment involving the ossicles -- the
three tiny bones that conduct sound from the tympanic membrane (ear
drum) to the oval window in the middle ear. When one has
sensorineural hearing loss, there can be many diagnoses, including
Meniere's Disease. The idea is to "differentiate" from among the
possible diagnoses to arrive at the correct, or best, diagnosis for
the particular patient.
Comment. Despite the description of a
wire penetrating the eardrum (tympanic membrane) in the Bandolier
article, many, perhaps most, ECoG's are not performed this way. In
many ECoG's, a sensor is placed in the outer ear canal and there is no
topical or other anesthesia, pain, or penetration of the ear drum.
Electronystagmography (ENG) (caloric stimulation test). Vertigo is induced by warm
or cold water or air introduced into the outer ear; the patient's eye
movements (called "nystagmus") are then observed to the extent that
they occur.
Videonystagmography (VNG).
VNG is similar to ENG (above), except that eye movements are studied
with cameras that are incorporated into goggles; a video recording is
made of the eye movements.
Blood tests, especially for
syphilis and cholesterol. Syphilis can mimic Meniere's Disease.
Physicians often test for syphilis in the face of Meniere's symptoms;
do not be insulted or take this "personal." High cholesterol can
impair hearing and mimic Meniere's Disease.
Computerized tomography (CT)
(or computer assisted tomography (CAT)) scan of the head. The purpose
of the CT scan is to determine whether there are abnormal masses in
the head and brain.
Magnetic resonance imaging (MRI)
scan of the head with "contrast" (gadolinium). One purpose of the MRI
scan is to determine whether there are any tiny tumors (acoustic
neuromas (AN)) on the vestibulocochlear (eighth cranial) nerve
or other observable masses -- possible reasons for the patient's
symptoms. Most or all AN's are benign and can be surgically removed;
however, there may be lasting consequences. MRI provides more detail
than does CT. Acoustic neuromas are also known as vestibular
schwannomas, acoustic neurinomas, and acoustic neurilemomas. An
MRI scan can detect other conditions that may mimic Meniere's Disease
symptoms, such as multiple sclerosis.
High resolution computerized
tomography (HRCT). This test may be performed to find or rule out
otosclerosis.
Vestibular evoked myogenic
potentials (VEMP). VEMP is a type of auditory testing,
usually performed by an audiologist, that some believe to be of value
in the diagnosis of Meniere's Disease. VEMP as a
diagnostic tool as applied to Meniere's Disease is somewhat
controversial and there are authorities pro and con. We believe
that VEMP has not gained wide acceptance among experts as applied to
Meniere's Disease.
Dr. Timothy Hain's
explanation. He reports that in his large practice, VEMP has
not been found to have "any use," but notes that other practices have
reported a different experience.
Mimics -- conditions that mimic Meniere's
Disease.
Many other diseases and conditions
can produce symptoms identical to or similar to the symptoms of
Meniere's Disease.
Meniere's Disease patients speak of these
other diseases and conditions as "mimics" of Meniere's Disease,
although it would be equally correct to say that Meniere's Disease is
a "mimic" of these other diseases and conditions.
Perilymph fistula (PLF). A small hole in one of the two
membranes ("oval window" (top) or "round window" (bottom)) that
separate the middle ear from the inner ear.
Superior canal dehiscence syndrome
(SCDS) or semicular canal dehiscence (SCD) or superior semicircular
canal dehiscence (SSCD). In this condition, bone between the
inner ear and the brain is either missing or insufficient, producing
symptoms similar to perilymph fistula (PLF) (above). Since the
symptoms of PLF are similar to the symptoms of Meniere's Disease, the
symptoms of SCDS are, therefore, similar to the symptoms of Meniere's
Disease.
Acoustic neuroma (AN). A benign
tumor, usually (but not always) very small, on the eighth cranial
(auditory and vestibular) nerve; usually treatable by surgical removal
or by radiation therapy, but some permanent loss of hearing and other
consequences may result. Most or all AN's are benign and can be
surgically removed; however, there may be lasting consequences. MRI
provides more detail than does CT. Acoustic neuromas are also
known as vestibular schwannomas, acoustic neurinomas, and acoustic
neurilemomas.
Non-idiopathic endolymphatic
hydrops, (as opposed to "idiopathic endolymphatic hydrops," the
prevailing (but not definitive theory) of the cause of Meniere's
Disease symptoms). Endolymphatic hydrops caused by some known
condition. Can be secondary endolymphatic hydrops (SEH), delayed
endolymphatic hydrops (DEH), or traumatic endolymphatic hydrops (TEH).
See more on our cause page.
Benign paroxysmal positional
vertigo (BPPV). Vertigo caused by dislodged calcium carbonate
crystals (canaliths) in the inner ear. This condition is almost always
very easily cured by head positioning maneuver sthat move the
dislodged crystals back to where they belong. The maneuvers are
called "Epley Maneuvers," and are named for Dr. John Epley
in Portland, Ore., who developed them. Dr. Epley found it
difficult to get his maneuvers accepted in the medical community, yet
today they are just about the only and are certainly the most
successful treatment (yes, Epley maneuvers actually cure most
people). His story is chronicled here.
Petrous apex cholesterol granuloma
(PACG) (not to be confused with primary angle closure glaucoma, also
abbreviated PACG). A type of lesion that can be visualized with
MRI.
Cogan's Syndrome (CS).
Cogan's Syndrome is described as Meniere's-like fluctuating hearing
loss combined with impaired caloric response, and may or may not be
accompanied by inflammation of the eye.
Microvascular compression syndrome (MCS) (also called "vascular
compression" and "neurovascular compression"). A blood
vessel pressing against the vestibulocochlear (8th cranial) nerve.
Some doctors consider this to be a "cause" of Meniere's Disease
symptoms, rather than a separate condition.
Minor LB.
Meniere's Disease and Migraine. Arch Otolaryngol Head Neck Surg.
2005 May;131(5):460. No abstract available. PMID: 15897429 [PubMed -
in process]
Boyev KP.
Meniere's disease or migraine? The clinical significance of
fluctuating hearing loss with vertigo. Arch Otolaryngol Head
Neck Surg. 2005 May;131(5):457-9. No abstract available. PMID:
15897428 [PubMed - in process]
This list is not intended to be
all-inclusive. No doubt there are many more mimics.
Non-Mimics.
Some patients seem to believe that the
following diseases and conditions are mimics of Meniere's
Disease. While they may produce one or two symptoms that somewhat resemble
Meniere's Disease, authoritative sources do not establish them as "mimics" of
Meniere's Disease, and they generally are not difficult to differentiate from
Meniere's Disease. (If you find authoritative sources that establish any
of them as "mimics,"
please email them to us.)
