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The diagnosis of Meniere's disease is based on:

• History and physical examination
• Laboratory testing
• Audiometric studies
• Balance tests
• Other tests
• Imaging studies

History and Physical Examination

The initial "work-up" for the diagnosis of Meniere's disease includes a detailed patient history followed by a physical examination. Sometimes, a diagnosis of Meniere's disease can be established based on the patient's detailed description of symptoms. The diagnosis may be strengthened by the presence of a positive family history of symptoms related to Meniere's disease, even if it was never formally diagnosed. The physician will need to ask the patient regarding hearing loss, tinnitus, or aural fullness since patients may be so overwhelmed with the vertigo that they forget about other symptoms.

The physician may listen to various portions of the head and neck with a stethoscope to rule out other reasons for tinnitus and the patient's eyes may also be examined to rule out other causes of nystagmus.

Laboratory Testing

Laboratory tests are rarely required for the diagnosis of Meniere's disease but sometimes may be used to help rule out other causes of hearing disorder or other symptoms. Some of the tests the doctor may order include:

• Complete Blood Count (CBC) to look for infection
• Tests to determine the presence or absence of metabolic diseases
• Blood test to rule out syphilis
• Measurement of cholesterol levels

Audiometric Studies

An audiogram records hearing accuracy for different tones (low - high frequencies) and loudness (decibel level). The patient with Meniere's disease may initially experience a low-frequency hearing loss.

Balance Tests

• Electronystagmogram - recording of eye movements are taken at rest, while moving the head left-right and up-down, when looking at a moving object, and/or when warm water, cold water, or air are injected into the ear canal. Normal function is reduced in the affected ear in approximately 50% of patients with Meniere's disease.
• Sharpened Romberg Test - patient walks placing the heel of one foot at the toe of the other while eyes are closed
• Dix-Hallpike Maneuver - the patient lies on a table with his head hanging over the end and then turns his neck to see if dizziness or nystagmus can be induced.
• Rotational Test - the patient sits in a chair that rotates quickly to see if vertigo, dizziness or nystagmus can be induced.

Balance tests tend to be normal in the early stages of Meniere's disease and show increasing dysfunction as the stages progress.

Other Tests

While the diagnosis of Meniere's disease can sometimes be established based on symptoms reported by the patient and some of the tests mentioned above, the clinician may find the need to investigate further either to establish the presence of Meniere's disease or to rule out other medical conditions. Other tests which may aid the physician in a diagnosis include:

• Tympanogram - tests middle ear pressure
• Auditory Brain Stem Response - a series of sounds is presented to each ear and electrical responses of the auditory nerve are recorded