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According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), Meniere's disease is characterized by four symptoms which appear with varying intensity:

• Vertigo
• Hearing loss
• Tinnitus
• Aural fullness

Vertigo

Vertigo is defined as "the sensation of motion when no motion is occurring relative to earth's gravity". Normally, when the brain receives conflicting information from the vestibular (balance) system in the inner ear and the somatosensory system (describes where a person is in space), it compensates for the difference, and the person may feel momentary vertigo or disequilibrium. When there are recurring incidences of asymmetric or conflicting information, the compensatory mechanism does not work efficiently. This is what happens to patients with Meniere's disease.

According to the AAO-HNS, there are three criteria for a vertigo attack to be considered in a diagnosis of Meniere's disease. The vertigo attacks must:

• Last at least 20 minutes
• Involve no loss of consciousness
• Be accompanied by the presence of horizontal nystagmus (rapid movement of the eyes from side to side)

The patient must experience at least two episodes fitting this description, particularly the minimum twenty-minute minimum duration. The vertigo may also be accompanied by nausea and vomiting.

The vertigo or spinning sensation felt during an attack is a rotational motion. Most patients report that either they themselves are spinning or the environment is spinning around them. It is often accompanied by nausea, vomiting and sweating, all of which can vary in intensity from mild to very severe. There also may be motion intolerance where any movement exacerbates the vertigo. Many patients report that when an episode of vertigo occurs, they lie down on the floor with their eyes open until the attack passes.

Vertigo attacks typically begin suddenly and may occur daily or as infrequently as once a year. Although the duration varies, episodes typically last 1-3 hours but rarely longer than 8-12 hours. One study indicated that attacks may last:

• Less than one hour in 25% of patients
• One to two hours in 50% of patients
• More than two hours in 25% of patients

Hearing Loss

Hearing loss in patients with Meniere's disease is sensorineural (caused by destruction of small hairs in the cochlea which transmit sound to the nerves) and must be documented on an audiometric exam since people with aural fullness often sense hearing loss though it may not be measurable. The AAO-HNS guidelines include specific frequencies and decibel-levels that are affected. The hearing loss associated with Meniere's disease is usually unilateral (occurring only in one ear).

There are two types of hearing loss that affect the patient with Meniere's disease: temporary, mild to severe hearing loss during the vertigo attack and slow, progressive, permanent hearing loss (may be complete) due to destruction of hair cells (nerve cells) caused by repeated Meniere's episodes.

Tinnitus

Tinnitus, or ringing in the ear, can be constant or intermittent and is typically unilateral. It is often described by patients with Meniere's disease as a sustained, loud ringing which does not abate, but the intensity of the ringing may vary. Other patients report a loud roar or buzzing, humming, or whooshing sound.