Most people referred to ENT with Meniere’s disease do not have the condition, which is NOT associated with mild or brief episodes of vertigo. BPPV and Vestibular migraine are much more common differential diagnoses for recurrent episodes of vertigo and should be considered first: please see the ENT Dizziness and Balance page for more detail.
If the patient has had a single episode of persistent vertigo +/- unilateral hearing loss with prolonged recovery, Vestibular Neuronitis or Labyrinthitis should be considered.
Meniere’s disease is characterised by recurrent attacks of:
- SEVERE AND DISABLING VERTIGO – fully incapacitating – so that the patient cannot stand or walk. Vertigo attacks are usually prolonged (persisting for hours).
- SIGNIFICANT unilateral HEARING LOSS – initially fluctuating and then more profound with progression.
- Unilateral TINNITUS – classically ‘roaring’, initially during attacks and eventually more persistent.
Unilateral ‘AURAL FULLNESS’ may be experienced by some – a sensation of pressure in the ear, or ear discomfort, often present in advance of a vertigo attack.
Any of these symptoms may predominate, and attacks can occur in clusters.
NICE has produced a helpful CKS on Meniere’s. A low salt / caffeine diet may help and the Meniere’s Society gives further detail, as well as extensive other information.
C.M. & L.McM. 25-03-25
Who to refer:
Where a diagnosis of Meniere’s needs to be confirmed – patients with disabling, prolonged vertigo attacks with associated symptoms (see above).
Please first:
- Please assess for BPPV with Dix-Hallpike testing as often both are present
- Advise about a low salt and caffeine diet
- Ask the patient to complete a symptom diary.
Who not to refer:
- Those with tinnitus but no other ENT symptoms – see Tinnitus page for advice about self-management or referral to Audiology.
- Those with symptoms suggestive of BPPV – see BPPV for details of referral to Audiology.
How to refer:
Please refer through SCI Gateway to ENT at LAURISTON ONLY.
