Differentiating Meniere’s Disease
Meniere’s Disease (MD) remains a diagnosis based on clinical signs and symptoms. Unfortunately, the signs and symptoms of MD are subjectively described by the patient and are interpreted by the professional (based on his or her area of expertise and professional orientation), which may lead to areas of overlap and confusion. Neff et al (2012) report that patients who experience "persistent unsteadiness or dizziness between vertigo attacks present difficult diagnostic challenges…."
Additionally, vestibular migraine (VM) presents with episodic vertigo and migraine headache and its "acute vestibular symptoms are frequently indistinguishable…" from those of MD. The authors report the reported incidence of MD is approximately 0.2 percent (USA) and the incidence of VM incidence is approximately 2 percent (USA). Neff et al note that patients with VM may present with spontaneous vertigo (lasting from seconds to days). Of note, hour-long attacks may mimic MD, whereas short attacks may appear similar to benign paroxysmal positional vertigo (BPPV). VM patients report intolerance of head motion, motion sickness, and episodic vertigo. Neff et al also report chronic subjective dizziness (CSD) is a "condition of chronic unsteadiness or non-vertiginous dizziness accompanied by hypersensitivity to motion stimuli and poor tolerance for complex visual stimuli…."
The authors conclude that large overlaps exist in audiovestibular symptoms, neurotologic examinations, lab testing, and "re-evaluations of current diagnostic criteria for MD, VM, and CSD are needed to reduce ambiguity and account for comorbidity."
For More Information, References, and Recommendations
Ferraro JA. (2010) Electrocochleography: A Review of Recording Approaches, Clinical Applications, and New Findings in Adults and Children. Journal of the American Academy of Audiology 21(3):145-152.
Ferraro JA, Beck DL, Speidel DP. (2011) Developments in Electrocochleography: 2011. Hearing Review, July.