The classification and treatment of Menière's disease

The classification and treatment of Menière's disease are especially difficult because the natural history of Menière's disease is so variable, and not possible to relate to the cochlear and vestibular pathology present, which is constantly changing and cannot be known during life. In the many new papers written each year on Menière's disease and the hundreds of older papers already in the medical literature, there is no good agreement about the definition of Menière's disease, the pathology and natural history, and the real benefit of the medical and surgical treatments given. Only recently, with transtympanic electrocochleography and three-dimensional CT scans of the external aperture of the vestibular aqueduct, have we significant information during life about the pathology present, from which to predict the likely natural history and the chances for successful treatment. This paper will define Menière's disease, will separate its pathology and natural history in five stages, and suggest reasonable methods of treatment for the stages for which treatment is possible.