Ménière’s Disease
Publication Date: April 8, 2020
Last Updated: November 8, 2022
Table 3. Summary of Key Action Statements (KAS)
Diagnosis of Ménière’s Disease
Clinicians should diagnose definite or probable Ménière’s disease in patients presenting with two or more episodes of vertigo lasting 20 minutes to 12 hours (definite) or up to 24 hours (probable) and fluctuating or non-fluctuating sensorineural hearing loss, tinnitus or pressure in the affected ear, when these symptoms are not better accounted for by another disorder. (R)
6889
Assessing for Vestibular Migraine
Clinicians should determine if patients meet diagnostic criteria for vestibular migraine when assessing for Ménière’s disease. (R)
6889
Audiometric Testing
Clinicians should obtain an audiogram when assessing a patient for the diagnosis of Ménière’s disease. (S)
6889
Utility of Imaging
Clinicians may offer magnetic resonance imaging (MRI) of the internal auditory canal (IAC) and posterior fossa in patients with possible Ménière’s disease and audiometrically verified asymmetric sensorineural hearing loss. (O)
6889
Vestibular or Electrophysiologic Testing
Clinicians should not routinely order vestibular function testing or electrocochleography to establish the diagnosis of Ménière’s disease. (R)
6889
Patient Education
Clinicians should educate patients with Ménière’s disease about the natural history, measures for symptom control, treatment options, and outcomes. (R)
6889
Symptomatic Management of Vertigo
Clinicians should offer a limited course of vestibular suppressants to patients with Ménière’s disease for management of vertigo only during Ménière’s disease attacks. (R)
6889
Symptom Reduction and Prevention
Clinicians should educate patients with Ménière’s disease on dietary and lifestyle modifications that may reduce or prevent symptoms. (R)
6889
Oral Pharmacotherapy for Maintenance
Clinicians may offer diuretics and/or betahistine for maintenance therapy to reduce symptoms or prevent Ménière’s disease attacks. (O)
6889
Positive Pressure Therapy
Clinicians should not prescribe positive pressure therapy for patients with Ménière’s disease. (R)
6889
Intratympanic Steroid Therapy
Clinicians may offer, or refer to a clinician who can offer, intratympanic steroids to patients with active Ménière’s disease not responsive to non-invasive treatment. (O)
6889
Intratympanic Gentamicin Therapy
Clinicians should offer, or refer to a clinician who can offer, intratympanic gentamicin to patients with active Ménière’s disease not responsive to non-ablative therapy. (R)
6889
Surgical Ablative Therapy
Clinicians may offer, or refer to a clinician who may offer, labyrinthectomy in patients with active Ménière’s disease who have failed less definitive therapy and have non-usable hearing. (R)
6889
Role of Vestibular Therapy for Chronic Imbalance
Clinicians should offer vestibular rehabilitation/physical therapy for Ménière’s disease patients with chronic imbalance. (R)
6889
Role of Vestibular Therapy for Acute Vertigo
Clinicians should not recommend vestibular rehabilitation/physical therapy for managing acute vertigo attacks in patients with Ménière’s disease. (R)
6889
Counseling for Amplification and Hearing Assistive Technology
Clinicians should counsel patients, or refer to a clinician who can counsel patients, with Ménière’s disease and hearing loss on the use of amplification and hearing assistive technology. (R)
6889
Patient Outcomes
Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Ménière’s disease after treatment. (R)
6889
Recommendation Grading
Overview
Title
Ménière’s Disease
Authoring Organization
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Publication Month/Year
April 8, 2020
Last Updated Month/Year
February 15, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Audiologist, nurse, nurse practitioner, physician, physician assistant, speech language pathologist
Scope
Diagnosis, Assessment and screening, Management
Diseases/Conditions (MeSH)
D008575 - Meniere Disease
Keywords
fluctuating aural symptoms, Meniett device, sensorineural hearing loss, Ménière’s