Diagnosis of Meniere's Disease

Differential Diagnosis of Meniere's Disease

The diagnosis of Meniere's disease can be challenging because it may difficult to recognize until the classical symptoms develop and other causes have been excluded. Some of the conditions that need to be distinguished from Meniere's disease include:

• Benign paroxysmal positional vertigo (BPPV) - episodes of short-lasting vertigo that are usually brought on by movement and are not associated with hearing loss or tinnitus. BPPV can be due to numerous causes including head injury or debris from small calcifications that lodge in the vestibular system.
• Acoustic neuroma - a slow growing tumor of the auditory nerve that can cause symptoms similar to Meniere's disease
• Vestibular neuritis - viral inflammation of the vestibular nerve that causes vertigo
• Labyrinthitis - inflammation of the labyrinth that causes dizziness, imbalance, and temporary hearing loss
• Acute hearing loss - could be idiopathic (no observable reason)
• Perilymphatic fistulas - a small opening usually in the round window or oval window that allows perilymph to seep into the middle ear and can cause vertigo, nystagmus, and extreme motion sensitivity
• Vertebrobasilar insufficiency (VBI) - insufficient blood supply to certain parts of the brain that can cause dizziness, vertigo, and visual problems
• Multiple sclerosis
• Arnold-Chiari malformation
• Migraine headaches - can cause dizziness
• Side effects of medications/drugs - some (e.g., aspirin, NSAIDs) may cause tinnitus
• Head injury - can cause multiple symptoms similar to Meniere's disease
• Eustachian tube dysfunction, wax buildup, middle ear infection can cause aural fullness or hearing loss
• Presbycusis - slow and steadily increasing hearing loss commonly found with advancing age
• Exposure to toxic chemicals - can cause multiple symptoms similar to Meniere's disease
• Syphilis - can cause damage to the inner ear and lead to symptoms similar to Meniere's disease

Often, the pattern of onset and progression of acute attacks is helpful in the differential diagnosis. Many of the commonly confused conditions begin with mild symptoms and build up in intensity, whereas, the patient with Meniere's disease will typically experience sudden attacks of intense whirling vertigo, (sometimes preceded by aural fullness, tinnitus, or hearing loss) which last for minutes to hours and gradually subside. There is no lasting feeling of vertigo between attacks though some people report a continuing sense of unsteadiness on their feet.