Meniere’s Disease
Ménière’s disease is diagnosed based on the symptoms of sensory/neural hearing loss, vertigo, tinnitus, and aural full- ness (Committee on Hearing and Equilibrium, 1995) as well as the exclusion of other known diseases. Adding to the diagnostic challenge, the four symptoms do not occur all at once, and some of them may occur only during the inter- mittent attacks that characterize this disease. It takes, on average, 1 year after the first symptom occurs before all of the symptoms are experienced by a person stricken with this disease.
Ménière’s disease rarely occurs before age 20 and is most likely to begin between the fourth and sixth decades (Pfaltz and Matefi, 1981).
Ménière’s disease usually begins as a unilateral sensory/ neural hearing loss, but the frequency of bilateral involve- ment increases with disease duration (Stahle and Klockhoff, 1986). Although audiometric configuration is not too help- ful in diagnosing Ménière’s disease, a peaked audiogram (described in Table 3.3) is most common (roughly 60% of involved ears), and a rising audiogram is also seen quite frequently, especially in the earliest stages of the disease. However, the peaked audiogram is also seen in 13% of ears with acoustic tumors (Ries et al., 1998).
Ménière’s disease rarely occurs before age 20 and is most likely to begin between the fourth and sixth decades (Pfaltz and Matefi, 1981).
Ménière’s disease usually begins as a unilateral sensory/ neural hearing loss, but the frequency of bilateral involve- ment increases with disease duration (Stahle and Klockhoff, 1986). Although audiometric configuration is not too help- ful in diagnosing Ménière’s disease, a peaked audiogram (described in Table 3.3) is most common (roughly 60% of involved ears), and a rising audiogram is also seen quite frequently, especially in the earliest stages of the disease. However, the peaked audiogram is also seen in 13% of ears with acoustic tumors (Ries et al., 1998).
Practical Audiology
Signs from the Case History
Site of Lesion
Severity of Loss
Tympanometry
Acoustic Reflexes
OAEs
Pure Tone Audiometry
Speech Audiometry (SRT/WRS/QuickSIN)
Additional testing for confirmation of diagnosis
- Hallmark: Roaring Tinnitus
- Dizziness, vertigo
- Decreased hearing thresholds
- aural fullness
- Hyperacusis (increased sensitivity to sounds)
- Episodic, potentially sensitive to the weather
Site of Lesion
- Cochlea/SNHL
Severity of Loss
- Begins as low-frequency loss
- Progressively worsens to flat loss
Tympanometry
- Type A; normal (no ME involvement)
Acoustic Reflexes
- Present or at normal levels
- Do not run if they are having an attack!
- No reflex decay
OAEs
- Amount of HL will correlate with the presence or absence of OAEs
- Will reflect cochlear damage
Pure Tone Audiometry
- SNHL
Speech Audiometry (SRT/WRS/QuickSIN)
- SRT/PTA agreement
- Word Recognition Scores depressed during an episode
Additional testing for confirmation of diagnosis
- ABR used to rule out retrocochlear involvement
- MRI or CT scan to rule out retrocochlear lesions
- Vestibular testing
- EcochG