Making the diagnosis
Diagnostic criteria
Ménière’s is unique among the episodic vertigos in resting on an audiogram: the difference between definite and probable disease is whether you have documented the hearing loss.
A consensus framework
There is no single test that proves Ménière’s. Doctors use an agreed checklist: enough attacks of the right length, a hearing test showing the loss, the ear symptoms that come and go, and ruling out other causes.
The Bárány Society and AAO-HNS published joint criteria in 2015, defining definite and probable disease.1 The pivotal requirement for definite disease is audiometrically documented low/mid-frequency sensorineural loss in the affected ear.
The practical message: capture an audiogram during or soon after an attack. Probable disease is the honest label until the loss is documented — and the 2020 clinical practice guideline reinforces audiometry plus targeted exclusion of mimics over routine imaging or electrophysiology in the typical case.3
Definite Ménière’s disease
All four must be met:
- A. ≥ 2 spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours.
- B. Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear, on at least one occasion.
- C. Fluctuating aural symptoms (hearing, tinnitus or fullness) in the affected ear.
- D. Not better accounted for by another vestibular diagnosis.
Probable disease relaxes the duration (up to 24 h) and drops the audiometric requirement: episodic vertigo with fluctuating aural symptoms, mimics excluded.1
Try it — the criteria checker
Toggle each criterion. Note that without the documented audiogram (criterion B) the best you can reach is probable disease — the whole reason to test hearing during symptoms.
Bárány / AAO-HNS criteria — checker
Audiometric staging
Once definite, the disease is staged by the four-tone pure-tone average (0.5, 1, 2, 3 kHz) of the worst audiogram in the six months before treatment — a simple way to track progression and frame prognosis.2
- ≤ 25 dBFluctuating, recovers between attacks
- 26–40 dBLow-frequency loss becoming fixed
- 41–70 dBFlat, moderate–severe loss
- > 70 dBSevere; hearing no longer fluctuates
Staged on the 4-tone pure-tone average (0.5, 1, 2, 3 kHz) of the worst audiogram in the 6 months before treatment.
Key points
- Definite = recurrent 20 min – 12 h vertigo + documented low/mid-frequency SNHL + fluctuating aural symptoms + exclusion.
- Probable drops the audiometric requirement and widens the duration to 24 h.
- Capturing an audiogram during symptoms is the single most useful diagnostic step.
- Stage by the 4-tone PTA of the worst audiogram before treatment.