Unilateral weakness (unilateral canal paresis) is the most common finding in bithermal caloric test in MD patients. It is observed in up to 73.5% of the patients, usually in the affected ear. Areflexia (complete absence of vestibular caloric response with ice water irrigation) has been observed in 6-11%. Directional preponderance can be found in 13-36% of the patients, but it is a nonlocalizing finding. It should be noted that caloric test may be normal in approximately 16-30%.

Saccades, smooth pursuit and OKN tests are usually normal in MD patients as abnormalities in these tests occur more frequently with CNS disorders.

The problem with this question is that a list of tests will be compiled, and many ENT patients may not fail these tests, especially if the disease is in a quiescent state. The temptation is then to tell the patient that they therefore do not have an ear problem, implying it is all a psychological condition. This may be so for Meniere's Disease, as strictly defined in ENT depatments. However, Meniere Spectrum Disorder, also caused by hydrops, is a very common and distressing condition, which I think is best diagnosed clinically, even with a symptom questionnaire.

Typical Meniere's disease can be diagnosed clinically as it is characterizes by a triad of recurred episode of vertigo (non positional), tennitus & flactuant decrease hearing which not preceeded by flue, ear infection or head trauma. ENT examination is normal. Audiovestibular investigation is to confirm and to help in post treatment F/U.

"Typical Meniere's disease can be diagnosed clinically as it is characterizes by a triad of recurred episode of vertigo (non positional), tennitus & flactuant decrease hearing"

There are many other symptoms, the two most important being

1. A feeling of blockage or fullness in the ear. This is usually misdiagnosed as a blocked Eustachian tube, or as headache if bilateral.

2. Audiosensitivity, oversensitivity to noise (not recruitment). This often occurs in the absence of any other obvious signs of ear involvement, and is usually thought wrongly to be of psychological or neurological origin.

I agree with Dr.Anthony but what i mentioned is typical Meniere's disease which i face frequently in ENT clinic & other mentioned symptoms by Dr.Anthony represent non typical MD which is infrequently seen in ENT clinic but not missed by Otolaryngologists.

Regards.

Dr.Hazem.

" Menière's disease is often linked to migraine. In such cases, we could expect some central abnormalities be present too."

Could we have examples of "central" abnormalities present in migraine that could not instead be possibly due to some subtle disorder of the peripheral vestibular system or of vestibular reflexes, and that are never seen in peripheral otovestibular diseases?

Patients with migraine and vestibular migraine also exhibit abnormal results in bedside examination and vestibular function testing, both during and between the attacks: spontaneous nystagmus, positional nystagmus, gaze-evoked nystagmus, saccadic pursuit, unilateral vestibular hypofunction. However, these findings are not specific for VM and can indicate either a peripheral or central origin.

Definite MD

A. Two or more spontaneous episodes of vertigo(1,2), each lasting 20 minutes to 12 hours(3).

B. Audiometrically documented low- to mediumfrequency sensorineural hearing loss(4,5) in one ear, defining the affected ear on at least one occasion before, during or after one of the episodes of vertigo(6,7).

C. Fluctuating aural symptoms (hearing, tinnitus or fullness) in the affected ear(8). D. Not better accounted for by another vestibular diagnosis(9).

Article Diagnostic criteria for Menière's disease