Diagnosis of Meniere's disease: routine and extended tests

Meniere's disease can compromise the quality of life of some patients in a manner so seriously that it can cause social segregation, even from family. Hearing loss, tinnitus, aural pressure, and disturbances in equilibrium added to an emotional instability frequently present in these patients may take them to a progressive state of solitude and depression, marking their lives by personal tragedy and making life a living hell. The clinical picture of Meniere's disease fluctuates, however. Individually, subsidiary examinations become impotent in diagnosing Meniere's disease. To be called Meniere's disease, the cause must be unknown; otherwise it would constitute Meniere's syndrome. Taking all of this into consideration, one would call this an unusual situation, or at least confusing. The lack of an etiologic diagnosis in medicine always creates anxiety for doctors and patients. What is considered to be either a routine or an extended test may change from service to service. The physician does not need to order all tests. What the physician needs is a protocol he or she trusts. Test results can vary, even depending on the moment when they are performed. More important than the number of tests ordered is the strategy by which the tests should be put together at that certain moment. The authors believe that one should have his or her own protocol for diagnosis, always beginning with a detailed history taking being guided by them most of the time. It is the authors' understanding that patients with Meniere's disease should be followed closely by their ear, nose, and throat doctor in episodes of vertigo or fluctuation of their hearing, tinnitus, or aural pressure. Should the patient be experiencing a stable period, a clinical visit along with an audiovestibular workup should be performed at least once a year. By monitoring the course of the disease, clinicians would be able to detect early changes in symptoms and/or test results, giving them the possibility to intervene clinically as early as possible in acute episodes of vestibulocochlear disorganization, protecting the inner ear, and minimizing sequelae from spells of hydrops. The authors believe that only the association of clinical sense and as many subsidiary tests as are useful will lead to a desirable level of certainty in the diagnosis of Meniere's disease, and will allow clinicians to presume bilateral involvement, monitor the development of the disease, intervene in its natural course, and idealize appropriate treatment.