Disorders · Introduction
Ménière’s disease
Recurrent spinning attacks that come with a roaring ear, a fluctuating muffled hearing and a sense of fullness — the audiovestibular disorder that, more than any other, you diagnose by documenting the hearing.
What Ménière’s disease is
Ménière’s disease is an inner-ear disorder causing attacks of severe dizziness lasting 20 minutes to 12 hours, together with hearing that comes and goes, ringing (tinnitus) and a feeling of pressure in one ear. It usually affects one ear and tends to come in clusters over years.
It is defined by recurrent spontaneous vertigo with fluctuating low-frequency sensorineural hearing loss, tinnitus and aural fullness in the affected ear, and is associated with endolymphatic hydrops.1 Early on the hearing recovers between attacks; over years it becomes fixed and progressive.
Ménière’s is a clinical diagnosis anchored on documented audiometry: the consensus criteria turn on capturing the low/mid-frequency sensorineural loss. It is also the great audiovestibular overlapper — coexisting with vestibular migraine more often than chance — and a diagnosis whose fluctuating natural history makes treatment effects notoriously hard to judge.3
Ménière’s by the numbers
Prevalence estimates vary widely by region and definition; onset peaks in midlife with a slight female predominance, and a minority become bilateral over time.2
Sex ratio
female male
Age of onset
peak onset in the forties–fifties
How this chapter is organised
- Pathophysiology & hydrops — endolymphatic hydrops and why it is a marker, not the whole story.
- Clinical features — the cardinal tetrad, the attack arc, the fluctuating audiogram and staging.
- Diagnostic criteria — the Bárány / AAO-HNS criteria, with an interactive definite-vs-probable checker.
- Differential diagnosis — separating it from vestibular migraine, BPPV, neuritis, SSCD and schwannoma.
- Treatment & management — the conservative-to-surgical ladder, and what the evidence really supports.
Key points
- Recurrent spontaneous vertigo (20 min – 12 h) with fluctuating low-frequency SNHL, tinnitus and aural fullness.
- Diagnosis hinges on documenting the sensorineural loss — capture an audiogram during symptoms.
- Usually unilateral; up to ~30% become bilateral over time.
- It overlaps and coexists with vestibular migraine — the key differential.
- Management is a stepwise ladder; no treatment cures it, and the fluctuating course flatters any intervention.