Guidelines Summary
American Academy of Otolaryngology‒Head and Neck Surgery Foundation
The American Academy of Otolaryngology‒Head and Neck Surgery Foundation (AAO-HNSF) published guidelines for the diagnosis and treatment of Ménière's disease (MD) in April 2020. [53]
Diagnosis
Definite MD should be diagnosed in patients presenting with the following:
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Two or more episodes of vertigo lasting 20 minutes up to 12 hours
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Audiometrically documented fluctuating low- to mid-frequency sensorineural hearing loss in the affected ear on at least 1 occasion before, during, or after one of the episodes of vertigo
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Fluctuating hearing loss, tinnitus, or pressure in the affected ear
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When these symptoms are not better accounted for by another disorder
Probable MD should be diagnosed in patients presenting with the following:
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Two or more episodes of vertigo lasting 20 minutes up to 24 hours
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Fluctuating hearing loss, tinnitus, or pressure in the affected ear
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When these symptoms are not better accounted for by another disorder
Clinicians should determine whether patients meet criteria for vestibular migraine diagnosis when assessing for MD.
Clinicians should obtain an audiogram when assessing a patient for MD.
Clinicians may offer MRI of the internal auditory canal and posterior fossa in patients with possible MD and audiometrically verified asymmetric sensorineural hearing loss.
Clinicians should not routinely order vestibular function testing or electrocochleography to establish diagnosis of MD.
Treatment
Clinicians should educate MD patients about the history of the disease, symptom control, treatment options, and potential outcomes, as well as lifestyle and diet modifications that may reduce or prevent symptoms.
Clinicians should offer a limited course of vestibular suppressants to MD patients for managing vertigo only during MD attacks.
Clinicians may consider diuretics and/or betahistine for maintenance therapy or prevention of MD attacks.
Clinicians should not prescribe positive pressure therapy to MD patients.
Clinicians may consider intratympanic steroids for MD patients who are nonresponsive to noninvasive treatment.
Clinicians should offer gentamicin to MD patients who are nonresponsive to nonablative therapy.
Clinicians may consider labyrinthectomy in MD patients who have failed less definitive therapy and have nonusable hearing.
Clinicians should offer vestibular rehabilitation/physical therapy for MD patients with chronic imbalance, but not for acute attacks of vertigo.
Clinicians should counsel MD patients on the use of amplification and hearing assistive technology.
Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss, and any change in quality of life in MD patients.
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Transtympanic instillation device is used to administer drugs to inner ear.
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Intraoperative view of the left ear treated with labyrinthectomy; endolymphatic sac can be seen in this view.
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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.
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Principles of Medical Management
- Pharmacologic Therapy
- Meniett Device
- Principles of Surgical Management
- Endolymphatic Sac Decompression or Shunt
- Vestibular Nerve Section
- Labyrinthectomy
- Cochlear Implant
- Transtympanic Perfusion of Medication
- Vestibular Rehabilitation
- Diet and Activity
- Prevention
- Consultations
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- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References
