Table 3. Summary of Key Action Statements (KAS)

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Ménière’s Disease

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Apr 8, 2020

Page Last Updated: May 5, 2026

Grading Table

Strength of Action Terms in Guideline Statements and Implied Levels of Obligation
Strength	Definition	Implied Obligation
Strong Recommendation (S)	A strong recommendation means that the benefits of the recommended approach clearly exceed the harms (or that the harms clearly exceed the benefits, in the case of a strong negative recommendation) and that the quality of the supporting evidence is excellent (grade A or B). In some clearly identified circumstances, strong recommendations may be made on the basis of lesser evidence, when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.	Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Recommendation (R)	A recommendation means that the benefits exceed the harms (or that the harms exceed the benefits, in the case of a negative recommendation) but that the quality of evidence is not as strong (grade B or C). In some clearly identified circumstances, recommendations may be based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms.	Clinicians should also generally follow a recommendation but should remain alert to new information and sensitive to patient preferences.
Option (O)	An option means that either the quality of evidence is suspect (grade D) or that well-done studies (grade A, B, or C) show little clear advantage to one approach versus another.	Clinicians should be flexible in their decision making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role.

Aggregate Grades of Evidence by Question Type
Grade	Treatment	Diagnosis	Prognosis
A	Systematic review^a of randomized trials	Systematic review^a of cross-sectional studies with consistently applied reference standard and blinding	Systematic review^a of inception cohort studies^b
B	Randomized trials, or observational studies with dramatic effects or highly consistent evidence	Cross-sectional studies with consistently applied reference standard and blinding	Inception cohort studies^b
C	Non-randomized or historically controlled studies, including case-control and observational studies	Non-consecutive studies, case-control studies, or studies with poor, non-independent, or inconsistently applied reference standards	Cohort study, control arm of a randomized trial, case series, or case-control studies; poor quality prognostic cohort study
D	Case reports, mechanism-based reasoning, or reasoning from first principles
X	Exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm

^a A systematic review may be downgraded to level B because of study limitations, heterogeneity, or imprecision
^b A group of individuals identified for subsequent study at an early, uniform point in the course of the specified health condition, or before the condition develops.

Document Overview

Document Title: Ménière’s Disease

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Document Publication Date: Apr 8, 2020

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599820909438

Source Citation: Basura GJ, Adams ME, Monfared A, et al. Clinical practice guideline: ménière’s disease. Otolaryngol Head Neck Surg. 2020;162(2_Suppl):S1-S55.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of Meniere's Disease.

Scope: Assessment and Screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D008575 - Meniere Disease

Keywords: Meniett device, Ménière’s, fluctuating aural symptoms, sensorineural hearing loss

Target Patient Population: Over 18 years old with suspected diagnosis of definite or probable Meniere's Disease

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Audiologist, Nurse, Nurse Practitioner, Physician, Physician Assistant, Speech-Language Pathologist

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Methodology Supplement Methodology Supplement

Number of Source Documents: 398

Literature Search End Date: Thursday, March 1, 2018

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Ménière’s Disease

Table 3. Summary of Key Action Statements (KAS)

Diagnosis of Ménière’s Disease

Assessing for Vestibular Migraine

Audiometric Testing

Utility of Imaging

Vestibular or Electrophysiologic Testing

Patient Education

Symptomatic Management of Vertigo

Symptom Reduction and Prevention

Oral Pharmacotherapy for Maintenance

Positive Pressure Therapy

Intratympanic Steroid Therapy

Intratympanic Gentamicin Therapy

Surgical Ablative Therapy

Role of Vestibular Therapy for Chronic Imbalance

Role of Vestibular Therapy for Acute Vertigo

Counseling for Amplification and Hearing Assistive Technology

Patient Outcomes

Grading Table

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology