Meniere Disease (Idiopathic Endolymphatic Hydrops) Differential Diagnoses

  • Author: John C Li, MD; Chief Editor: Robert A Egan, MD   more...
 
Updated: Sep 15, 2011
 
 

Diagnostic Considerations

In order to introduce uniformity in the diagnosis and treatment of Ménière disease, the American Academy of Otolaryngology issued guidelines in 1972. These guidelines were revised in 1985 and again in 1995.[15] The guidelines require analysis of symptoms, audiometric results, and functional impairment to allow staging. This staging tool is now widely used diagnostically and also as a measure of treatment outcome.

Other problems to be considered include the following:

  • Trauma
  • Endocrine abnormalities
  • Thyroid dysfunction
  • Hyperlipidemia
  • Diabetes
  • Congenital anomalies
  • Autoimmune problems/inner ear inflammation
  • Cogan syndrome
  • Otosclerosis
  • Perilymphatic fistula
  • Electrolyte imbalance
  • Barre-Lieou syndrome
  • Basilar meningitis
  • Brainstem tumors
  • Neoplasms (especially those associated with cranial nerve VIII, eg, acoustic neuroma)
  • Toxic or pharmaceutical injury to the vestibular apparatus
  • Vascular infarction of the labyrinth (usually associated with unilateral hearing loss)
  • Vasculitis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

John C Li, MD  Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM  Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Michael E Hoffer, MD  Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: American biloogical group Royalty Other

J Stephen Huff, MD  Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

R Gentry Wilkerson, MD  Assistant Professor, Director of Research, Emergency Medicine Residency Program, University of South Florida College of Medicine, Tampa General Hospital

R Gentry Wilkerson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Spiros Manolidis, MD  Associate Professor of Otolaryngology and Neurological Surgery, Columbia University

Spiros Manolidis, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Head and Neck Society, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Baxter Grant/research funds Other; Amgen Grant/research funds None

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

References

  1. Sajjadi H, Paparella MM. Meniere's disease. Lancet. Aug 2 2008;372(9636):406-14. [Medline].

  2. Paparella MM. Pathogenesis and pathophysiology of Meniére's disease. Acta Otolaryngol Suppl. 1991;485:26-35. [Medline].

  3. Merchant SN, Adams JC, Nadol JB Jr. Pathophysiology of Meniere's syndrome: are symptoms caused by endolymphatic hydrops?. Otol Neurotol. Jan 2005;26(1):74-81. [Medline].

  4. Paparella MM, Djalilian HR. Etiology, pathophysiology of symptoms, and pathogenesis of Meniere's disease. Otolaryngol Clin North Am. Jun 2002;35(3):529-45, vi. [Medline].

  5. Grasland A, Pouchot J, Hachulla E, Blétry O, Papo T, Vinceneux P. Typical and atypical Cogan's syndrome: 32 cases and review of the literature. Rheumatology (Oxford). Aug 2004;43(8):1007-15. [Medline].

  6. Fattori B, Nacci A, Dardano A, Dallan I, Grosso M, Traino C, et al. Possible association between thyroid autoimmunity and Menière's disease. Clin Exp Immunol. Apr 2008;152(1):28-32. [Medline]. [Full Text].

  7. Nacci A, Dallan I, Monzani F, Dardano A, Migliorini P, Riente L, et al. Elevated antithyroid peroxidase and antinuclear autoantibody titers in Ménière's disease patients: more than a chance association?. Audiol Neurootol. 2010;15(1):1-6. [Medline].

  8. Klockars T, Kentala E. Inheritance of Meniere's disease in the Finnish population. Arch Otolaryngol Head Neck Surg. Jan 2007;133(1):73-7. [Medline].

  9. Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. Feb 2004;17(1):9-16. [Medline].

  10. Kitahara M. Bilateral aspects of Meniére's disease. Meniére's disease with bilateral fluctuant hearing loss. Acta Otolaryngol Suppl. 1991;485:74-7. [Medline].

  11. Morrison AW, Johnson KJ. Genetics (molecular biology) and Meniere's disease. Otolaryngol Clin North Am. Jun 2002;35(3):497-516. [Medline].

  12. Mancini F, Catalani M, Carru M, Monti B. History of Meniere's disease and its clinical presentation. Otolaryngol Clin North Am. Jun 2002;35(3):565-80. [Medline].

  13. Havia M, Kentala E. Progression of symptoms of dizziness in Ménière's disease. Arch Otolaryngol Head Neck Surg. Apr 2004;130(4):431-5. [Medline].

  14. Stephens D, Pyykko I, Varpa K, Levo H, Poe D, Kentala E. Self-reported effects of Ménière's disease on the individual's life: a qualitative analysis. Otol Neurotol. Feb 2010;31(2):335-8. [Medline].

  15. Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. Sep 1995;113(3):176-8. [Medline].

  16. Paparella MM. Benign paroxysmal positional vertigo and other vestibular symptoms in Ménière disease. Ear Nose Throat J. Oct 2008;87(10):562. [Medline].

  17. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. Nov 2008;139(5 Suppl 4):S47-81. [Medline].

  18. Baloh RW, Jacobson K, Winder T. Drop attacks with Menière's syndrome. Ann Neurol. Sep 1990;28(3):384-7. [Medline].

  19. Kentala E, Havia M, Pyykkö I. Short-lasting drop attacks in Meniere's disease. Otolaryngol Head Neck Surg. May 2001;124(5):526-30. [Medline].

  20. White J. Benign paroxysmal positional vertigo: how to diagnose and quickly treat it. Cleve Clin J Med. Sep 2004;71(9):722-8. [Medline].

  21. Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. Jun 2002;35(3):581-9, vii. [Medline].

  22. Bronstein A. Visual symptoms and vertigo. Neurol Clin. Aug 2005;23(3):705-13, v-vi. [Medline].

  23. Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. Aug 2000;120(5):615-9. [Medline].

  24. de Sousa LC, Piza MR, da Costa SS. Diagnosis of Meniere's disease: routine and extended tests. Otolaryngol Clin North Am. Jun 2002;35(3):547-64. [Medline].

  25. Coelho DH, Lalwani AK. Medical management of Ménière's disease. Laryngoscope. Jun 2008;118(6):1099-108. [Medline].

  26. Cope D, Bova R. Steroids in otolaryngology. Laryngoscope. Sep 2008;118(9):1556-60. [Medline].

  27. Herraiz C, Plaza G, Aparicio JM, Gallego I, Marcos S, Ruiz C. Transtympanic steroids for Ménière's disease. Otol Neurotol. Jan 2010;31(1):162-7. [Medline].

  28. Phillips JS, Prinsley PR. Prescribing practices for Betahistine. Br J Clin Pharmacol. Apr 2008;65(4):470-1. [Medline]. [Full Text].

  29. Mira E, Guidetti G, Ghilardi L, Fattori B, Malannino N, Maiolino L, et al. Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. Eur Arch Otorhinolaryngol. Feb 2003;260(2):73-7. [Medline].

  30. Huang W, Liu F, Gao B, Zhou J. Clinical long-term effects of Meniett pulse generator for Meniere's disease. Acta Otolaryngol. Oct 15 2008;1-7. [Medline].

  31. Dornhoffer JL, King D. The effect of the Meniett device in patients with Meniere's disease: long-term results. Otol Neurotol. Sep 2008;29(6):868-74. [Medline].

  32. Mattox DE, Reichert M. Meniett device for Meniere's disease: use and compliance at 3 to 5 years. Otol Neurotol. Jan 2008;29(1):29-32. [Medline].

  33. Odkvist LM, Arlinger S, Billermark E, Densert B, Lindholm S, Wallqvist J. Effects of middle ear pressure changes on clinical symptoms in patients with Ménière's disease--a clinical multicentre placebo-controlled study. Acta Otolaryngol Suppl. 2000;543:99-101. [Medline].

  34. Silverstein H, Smouha E, Jones R. Natural history vs. surgery for Meniere's disease. Otolaryngol Head Neck Surg. Jan 1989;100(1):6-16. [Medline].

  35. Wetmore SJ. Endolymphatic sac surgery for Ménière's disease: long-term results after primary and revision surgery. Arch Otolaryngol Head Neck Surg. Nov 2008;134(11):1144-8. [Medline].

  36. Smith WK, Sandooram D, Prinsley PR. Intratympanic gentamicin treatment in Meniere's disease: patients' experiences and outcomes. J Laryngol Otol. Sep 2006;120(9):730-5. [Medline].

  37. Banerjee AS, Johnson IJ. Intratympanic gentamicin for Ménière's disease: effect on quality of life as assessed by Glasgow benefit inventory. J Laryngol Otol. Oct 2006;120(10):827-31. [Medline].

  38. Hsieh LC, Lin HC, Tsai HT, Ko YC, Shu MT, Lin LH. High-dose intratympanic gentamicin instillations for treatment of Meniere's disease: long-term results. Acta Otolaryngol. Dec 2009;129(12):1420-4. [Medline].

  39. Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. Oct 2004;37(5):955-72, v. [Medline].

  40. Monsell EM, Wiet RJ. Endolymphatic sac surgery: methods of study and results. Am J Otol. Sep 1988;9(5):396-402. [Medline].

  41. Glasscock ME 3rd, Jackson CG, Poe DS, Johnson GD. What I think of sac surgery in 1989. Am J Otol. May 1989;10(3):230-3. [Medline].

  42. Bretlau P, Thomsen J, Tos M, Johnsen NJ. Placebo effect in surgery for Meniere's disease: nine-year follow-up. Am J Otol. Jul 1989;10(4):259-61. [Medline].

  43. Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. Jan 20 2010;CD005395. [Medline].

  44. Shea JJ Jr, Ge X. Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin. Otolaryngol Clin North Am. Apr 1994;27(2):317-24. [Medline].

  45. Pyykko I, Ishizaki H, Kaasinen S, Aalto H. Intratympanic gentamicin in bilateral Meniere's disease. Otolaryngol Head Neck Surg. Feb 1994;110(2):162-7. [Medline].

 
Previous
Next
 
Transtympanic instillation device is used to administer drugs to inner ear.
Intraoperative view of the left ear treated with labyrinthectomy; endolymphatic sac can be seen in this view.
Tinnitus model. Two phenomena in auditory cortex are associated with peripheral deafferentation: (1) hyperactivity in lesion projection zone and (2) increased cortical representation of lesion-edge frequencies (here, C6) in lesion projection zone. These 2 phenomena are presumed to be neurophysiologic correlates of tinnitus. Red letters correspond to octave intervals of fundamental frequency.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.