Disease Patterns
Ménière's Disease
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Signature on CDP
The figure below shows the archetypal Ménière's pattern across the six SOT conditions, MCT response, and ADT adaptation, compared against an age-matched normal reference.
Audiometric companion
The audiogram below shows the typical hearing signature for this disorder. Reading the audiometric and CDP signatures together is often more informative than either alone.
Ménière's disease — characteristic low-to-mid-frequency sensorineural loss on the affected (right) ear.
Ménière's classically produces a low-to-mid-frequency sensorineural hearing loss on the affected ear, with relatively preserved high frequencies in early disease. The pattern fluctuates with attacks, particularly early in the disease course. Paired with an interictal CDP showing mild C5/C6 reduction on the same side, the audiometric and vestibular signatures are mutually supporting.
In this module
- Ménière's disease overviewFoundation · Trainee · Clinician
- Interictal CDPFoundation · Trainee · Clinician
- Fluctuation and serial assessmentTrainee · Clinician
Ménière's disease overview
Ménière's disease is defined clinically (Bárány Society 2015) by recurrent vertigo attacks lasting 20 minutes to 12 hours, with audiometrically documented low-to-medium frequency sensorineural hearing loss on the affected ear and fluctuating aural symptoms (fullness, tinnitus) on the same side.
The disease evolves over years. Early on, attacks are infrequent and hearing recovers between them. Over time, attack frequency may increase, hearing loss becomes permanent, and the vestibular function on the affected side gradually declines toward stable hypofunction.
CDP plays a supporting role. It is not part of the diagnostic criteria; the clinical picture and audiometric documentation carry the diagnosis. CDP can document interictal vestibular function, track fluctuation across attacks, and identify the rare patient whose Ménière's-like picture is actually something else.
Interictal CDP
Between attacks, CDP in Ménière's typically shows a mild-to-moderate vestibular pattern: condition 5 and 6 scores below age-matched norms but not zero, with C1–C4 generally intact. The pattern is similar in shape to vestibular neuritis but usually less severe.
Shin and colleagues (2013) found that interictal Ménière's patients show milder vestibular SOT findings than acute vestibular neuritis patients, with substantial overlap between the two groups. CDP cannot reliably distinguish the diagnoses on pattern alone.
Some Ménière's patients have entirely normal interictal CDPs, especially in the early disease course. A normal interictal CDP does not exclude the diagnosis — clinical criteria and audiometry do that work.
Fluctuation and serial assessment
The defining feature of Ménière's is fluctuation. Hearing fluctuates with attacks. Vestibular function fluctuates with attacks. CDP findings, measured serially, fluctuate too — typically worsening within a few days of an attack and improving over the subsequent weeks.
Serial CDP is therefore more informative than a single snapshot in this group. A patient with a normal CDP two weeks after their last attack tells you much less than the same patient with three CDPs over three months showing a pattern of worsening-then-recovery.
Late-stage Ménière's, after burnout of the affected labyrinth, typically shows a stable mild-to-moderate vestibular pattern. The fluctuation is gone because the residual function is no longer changing.