Clinical evaluation of Ménière's disease

A retrospective review of 211 consecutive patients with classic Meniere's disease was performed to determine the efficacy of diagnostic studies. The patients' ages averaged 47 years and ranged between 8 and 86 years. Females outnumbered males 1.3 to 1. Left and right ears were affected with equal frequency and, in 12% of patients, the disease was bilateral. Audiologic patterns were flat in 42%, rising in 7%, peaked in 32%, and sloping downward in the remaining 19%. Electronystagmography was normal in 21% of the patients and demonstrated canal paresis in 65% and directional preponderance in 14%. Studies of glucose metabolism were abnormal in 2 of the 204 patients tested. The 7 patients not tested had a previous diagnosis of diabetes mellitus. Thyroid function studies were abnormal in 1 of the 208 patients studied. The 3 patients not studied were known hypothyroid. FTA-abs was positive in 12 patients and special radiographic studies of the petrous apex were normal in all cases. Conclusions suggested by this study are that audiology, electronystagmography, and treponemal antigen tests for syphilis are cost effective in evaluating patients with Meniere's disease. Studies of glucose metabolism and thyroid function, however, are probably not indicated in patients without a history suggestive of a metabolic disorder and specialized radiographs of the petrous apex should be reserved for patients suspected of having acoustic neuroma.