clinical diagnosis

Last reviewed 01/2018

diagnosis

Meniere's disease is a clinical diagnosis. Patients usually present with episodic dizziness.

• acute episodes of vertigo should be differentiated from non-rotatory dizziness 
• ask the question  "did you just feel lightheaded or did you see the world spin around as though you just got off a playground roundabout?
  
  
• no - then could be presyncope,  lightheadedness, and disequilibrium in elderly people
  
  
• yes - rule out "red flags" suggesting brainstem stroke or other central signs, do confirmatory test to rule out other common causes of vertigo
  
  
• Hallpike manoeuvre - for benign positional vertigo, head thrust test -  for acute vestibular neuritis
  
  
• if both are negative consider
• vestibular migraine - if vertigo plus migraine is recurrent
• Meniere's disease - transient unilateral hearing loss or tinnitus, and previous episodes of dizziness

Reference:

• (1) Harcourt J, Barraclough K, Bronstein AM. Meniere's disease. BMJ. 2014;349:g6544