Understanding Meniere's Disease Diagnosis: A Comprehensive Guide
Introduction
Meniere's disease can be a challenging condition to diagnose, as the symptoms can be similar to those of other inner ear disorders. However, a proper diagnosis is critical to developing an effective treatment plan. In this article, we will explore the process of Meniere's disease diagnosis, including the different tests and techniques used by healthcare professionals to identify and confirm the presence of the condition.
The process of diagnosing Meniere's disease typically starts with a thorough medical history and physical examination. The doctor will ask about the symptoms you have been experiencing, including the frequency and severity of vertigo, tinnitus, and hearing loss. They may also perform a hearing test to evaluate your ability to hear low and high-frequency sounds.
In some cases, the doctor may also order imaging tests, such as an MRI or CT scan, to get a better look at the inner ear and surrounding structures. These tests can help rule out other potential causes of your symptoms, such as a brain tumor or a stroke.
One of the most commonly used diagnostic tools for Meniere's disease is the caloric test, also known as the vestibular function test. This test measures the response of the inner ear to warm and cool air stimulation, and can help identify problems with the balance and vestibular systems.
Another test that may be performed is the electrocochleography (ECOG) test, which measures the electrical activity of the inner ear in response to sound. This test can help determine the cause of tinnitus and assess the function of the inner ear.
Finally, a lengthy period of observation and monitoring may be necessary to confirm a diagnosis of Meniere's disease. This may involve tracking symptoms, including vertigo attacks, and making changes to your lifestyle and diet to help manage symptoms and improve overall health.
Meniere's disease can be a complex and challenging condition to diagnose, but with the help of healthcare professionals and the right tests and techniques, an accurate diagnosis can be made. By working together with your doctor, you can develop a personalized treatment plan that will help you manage your symptoms and live a full and fulfilling life.
Because the exact cause of your symptoms are unknown before diagnosis, it is really important to get a correct diagnosis. In order to rule out other problems, a very detailed history and physical examination will be required. Several tests using technology will also be carried out.
You will probably be sent to one or more specialists: an otolaryngologist (ear nose and throat) or a neurologist (brain). The eyes, ears, and brain are in close proximity.
The semicircular canals of the inner ear, which contain various fluids, plus the 8th cranial nerve, control balance and your positional sense. It is believed that Meniere's disease involves inflammation of the part of the canal that controls the filtration and excretion of the fluid in the inner ear.
You will be checked for the possibility of middle ear infections, otitis media, syphilis, and possibly head injury.
Being diagnosed with Meniere's Disease is important in that this diagnosis rules out other more sinister possibilities, such as acoustic neuroma (tumor).
That said, a diagnosis of Meniere's is really confirming only that you have a set of symptoms that the doctors do no know the origin of. The standard acceptance of Meniere's is what the medical profession quote as being a "triad of symptoms". Those being: Dizziness, tinnitus and hearing loss.
If you only have one of these symptoms usually the doctors will not diagnose Meniere's. Dissiness and tinnitus have many causes. Several of which can be side effects of prescription drugs. What the doctors are actually diagnosing you with is an idiopathic set of symptoms that are grouped together under the label "Meniere's".
No clinically proven definitive cause has been accepted yet, but as discussed elsewhere on this site, everything has a cause. Nothing happens without a reason and the cause or causes for your symptoms can be found and dealt with.
This takes some effort on your part because once you have been diagnosed, your doctor is telling you he or she doesn't know your cause and will only attempt to "treat" the symptoms. The good news is, although few doctors recognize this fact, you CAN find your cause(s) and deal with it. This is backed up by scientific medical studies and data.
Click here to read The Need for Balance - Dealing with the Causes of Meniere's disease
Diagnostic Tests For Meniere's Disease Symptoms
Diagnostic tests will include MRI, EEG, Audiometry Tests (Hearing) including Electronystagmography, Transtympanic electrocochleography (ECOG)1. Your History
You will be asked to describe what happens when you have an attack. It is a good idea to think about this and perhaps write all this down before visiting the doctor, give the doctor a copy of your description if need be.
He will need a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss and whether it has been changing, getting worse or fluctuating.
You will be asked if you have any history of: diabetes, high blood pressure, high blood cholesterol, thyroid, neurological or emotional disorders, tinnitus or fullness in either or both ears, syphilis, mumps, or other serious infections in the past, inflammations of the eye, auto-immune disorders or allergy, or ear surgery in the past.
A physical examination of the ears and other structures of the head and neck will be done, but these findings are usually normal, except during an attack.
2. Magnetic Resonance Imaging "MRI"
This may be one of the first tests, as it simply rules out any abnormal physical conditions in your head. It provides detailed pictures of brain and nerve tissues from multiple planes without obstruction by overlying bone.
An MRI can clearly show various types of nerve tissue. It provides clear pictures. It is noninvasive and can evaluate blood flow and the flow of cerebrospinal fluid (CSF). An MRI can distinguish tumors or other lesions from normal tissues. MRI is sometimes used to avoid the dangers of repeated exposure to radiation if you have had multiple x-rays in recent times.
The MRI scanner is in an area that has been shielded from outside magnetic fields. You lie on a narrow table that can slide inside a large tunnel-like tube within the scanner. The scanner creates a magnetic field around you, then directs radio waves at the tissues in question. Several sets of images are usually required, each taking from 2 to 15 minutes. The complete scan takes about 1 hour; some scans take more than 90 minutes. This test should not cause any discomfort.
3. Electroencephalogram "EEG"
An EEG helps to diagnose the presence of any type of seizure disorders, confusion, head injuries, brain tumors, infections, degenerative diseases, and metabolic disturbances that all could affect the brain.
It is be done by an specially-trained technician in a room designed for this purpose only. It may be in an office or in a hospital setting. You will be asked to lie on your back on the table or to sit in a reclining chair. Many flat metal discs (electrodes) will be placed in different positions on your scalp. (They are held in place with a sticky paste.)
These electrodes are connected by wires to an amplifier and a recording machine. The recording machine converts the electrical signals into a series of wavy lines. (Like an ECG.) These are then shown on a monitor and can be printed out. Because any movement can alter the results, you will need to lie very still with your eyes closed. You may be asked to do certain things during the recording, such as breathe deeply and rapidly for several minutes or look at a very bright flickering light. (It will be OK to move during these requests.) This test is without discomfort.
4. Hearing Tests: Audiometry/Audiology
These measure hearing ability. There are several different ones. Each is done for a specific purpose.
An audiometric examination typically indicates a sensory type of hearing loss in the affected ear. With Meniere's disease the ability to distinguish "sit" and "fit" is often diminished in the affected ear. (Speech discrimination)
Audiometry is particularly helpful in making the diagnosis of Meniere's syndrome. This can determine and measure low frequency or mixed low and high frequency, "Pike's Peak" pattern. When trying to make a diagnosis of Meniere's, it is very useful to have precise documentation of fluctuating hearing loss.
How the test is performed
Audiography provides a more precise measurement of hearing. Air conduction is tested by having you wear earphones attached to the audiometer. Pure tones of controlled intensity are delivered, usually to one ear at a time. You are asked to indicate when they hear a sound, and the minimum intensity required to hear each tone is graphed. An attachment is placed against the bone behind each ear to test bone conduction.
5. Transtympanic electrocochleography (ECOG)
This can show evidence for cochlear involvement. It may indicate increased inner ear fluid pressure in some cases of Meniere's disease.
6. Electronystagmography "ENG"
This test may be performed to evaluate balance function.
7. Caloric Stimulation
Caloric stimulation is performed to evaluate the acoustic nerve, which provides hearing and helps with balance. This test may be recommended when the person is experiencing dizziness or vertigo, when there is impaired hearing, with suspected toxicity from certain antibiotics, with some anemia, when psychological causes of vertigo are suspected.
How the test is performed
Each ear is tested separately. One teaspoon of cold water is gently instilled in the ear canal with a bulb syringe. This should cause nystagmus (quick movement of both eyes away from the direction of ice water and then slowly back). If it does not cause nystagmus, 2 teaspoons of cold water are instilled in the ear canal. If nystagmus still fails to occur, 4 and then 8 teaspoons of cold water are used.
At times, hot water may be used in addition to cold water. The nystagmus should occur in the opposite direction (toward the hot water then slowly away). Use of both cold water and hot water makes the test more accurate.
Meniere's diagnosis explained
The function of the ear is to detect sound vibrations from your environment and translate these vibrations into sound message to the brain, allowing you to hear. The ear has 3 distinct parts: the outer ear, the middle ear, and the inner ear. The outer ear catches the sound vibration and carries it into the middle ear and the tympanic membrane (eardrum). This membrane is like a filter and separates the outer ear from the middle ear.
The sound waves make the eardrum vibrate. This "translates" the vibrations. The middle ear has three bones that stretch from the tympanic membrane to the start of the inner ear (oval window). These bones are all connected from the tympanic membrane to the oval window. Their function is to transmit the vibrations into the cochlea and the fluid found in the inner ear (endolymph). The inner ear has several parts. Some of its more prominent parts are the cochlea, semicircular canals, and vestibulo-cochlear nerve and its branches. (vestibular/balance and acoustic/hearing nerves).
Deep in the cochlea are special hearing receivers. These receivers are stimulated by this vibrating fluid, and their message of sound is transmitted to the hearing/balance nerves, as electrical impulses. These impulses are then relayed to your brain (brain stem) for interpretation.
Two main functions of the inner ear have to do with hearing ("acoustic" or "auditory") and balance ("vestibular"). The nerves then communicate with the brain (cerebellum). The appropriate part of the brain will then interpret the message and give commands back to the ear. These commands will relate to hearing and balance. "Classic" Meniere's symptoms include: hearing fluctuation, ear pressure, tinnitis (a variety of sounds or ear noises), vertigo, and/or dizziness.
So the testing is done to check for abnormal responses related to balance and hearing.ECoG: a hearing test. Elecrocochleography is a complex hearing test designed to record the electrical activity of the cochlea, a part of the inner ear. It is done with a special computer. Sound is put into the ear, where it is transformed into vibrations in the middle ear. (Your ear does this naturally and automatically all the time.) And then these vibrations are turned into electrical impulses in the inner ear. This test records and measures this electrical activity. These results are then compared to established patterns typical of normal hearing and of Meniere's. Hydrops (Meniere's) is suggested when the ratio is greater than 35%.
Balance is not involved with this part.
"SP" & "AP" measure certain parts of these impulses. The ratios refer to established patterns associated with Meniere's. Hydrops is suggested when the ratio is greater than 35%. The SP:AP ratios give definite numbers which also help in the diagnosis.
Audiogram is a test that also measures hearing.
When trying to make a diagnosis of Meniere's, it is very helpful to have precise documentation of fluctuating hearing loss.
Audiometry is the computer technique that records the faintest levels of sounds that the person can hear. It is a graph or chart of hearing. It is a relatively simple way to determine levels of hearing sounds. Audiometry is particularly helpful in making the diagnosis of Meniere's. There may be a low frequency or mixed low and high frequency. A documented fluctuating hearing loss, especially in the low frequencies, is very helpful.
Speech thresholds refers to the level at which you can hear sounds.
"Discrim" refers to discrimination and that means how well you recognize a spoken word.
Tympanogram
The tympanic membrane is the eardrum. It separates your outer ear from the middle ear. This test checks for the "health" or "permeability" of this membrane. It needs to be pliable and responsive to sounds being transformed into vibrations. The tympanic membrane should appear smooth and symmetrical to function properly.
A tympanogram is a graph or recording showing the "permeability" or health of this membrane to sounds or air. A negative or abnormal graph could be the result of blockages or interruptions ("impediments"). This test shows how well the membrane is functioning. It does this by observing its response to waves of pressure. It also measures the pressure of the middle ear. Remember this is where the sound is transformed into vibrations.
Tympanometry can identify abnormal results. This MIGHT mean any number of things: fluid in the middle ear, perforated ear drum, impacted ear wax scarring of the tympanic membrane, lack of contact between the conduction bones of the middle ear, or a tumor in the middle ear.
Electronystagmography "ENG": is the record or a graph showing eye movements. Electronystagmography records and interprets or assesses movements in certain eye muscles.
This test has to do with hearing and balance.
A test called "Caloric (pertaining to heat) Stimulation" is performed to evaluate function of the hearing nerve, which provides hearing and helps with balance. The actual test wants to create a specific response.
This test is done by putting warm air or water into the ear canal and recording the eye movements through special electrodes. The test can include either air or water. And the temperature usually includes both warm and cold water. If the vestibular (balance) part is normal, the irrigation results WILL produce equal values of jerky movements. If it is diseased, the results will be fewer or reduced jerky movements. This test may be recommended when the person is experiencing dizziness or vertigo, when there is impaired hearing, with suspected toxicity from certain antibiotics, with some anemia, when psychological causes of vertigo are suspected.
This test should cause nystagmus: jerky eye movements.
Visual tracking: (visual dysmetria testing) this tests the ability of the eye to focus on a particular object or a moving target.
ABR: auditory brain stem. This is another computerized hearing test, but it is following the electrical paths to and into the brain. This test measures the sound waves (messages) which have been transformed into vibrations. These vibrations are then transformed into electrical impulses in the cochlea. Then they end up in the brain stem. Here the impulse is interpreted and the appropriate command is returned to the person. This test checks the route the message travels.
For Meniere's Disease to be considered, your overall responses would lead results that show a weakness or lack in each test.
This information is not to be used as a diagnostic tool but just to help you understand the tests. Please consult your doctor first if you have questions about your own symptoms.
This information is intended to help you understand your body and its functions. If you have a medical problem, please seek appropriate advice.
References/Further reading:
https://www.nidcd.nih.gov/health/menieres-disease
Mayo Clinic Diagnosis of Meniere's disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926973/
ENT test for Meniere's
Supporting Meniere's Sufferers Since 2004 - email: meniereshelp@gmail.com
