Meniere's disease: A mystery! Our way to diagnose

Haris Manzoor Qadri, Arun Dehadaray, Maitri Kaushik, Danish Zamir Andrabi

Indian Journal of Otology 2017 23(1):13-16

Introduction: Meniere's disease (MD) has long posed a diagnostic challenge. Characterized by recurrent vertigo, tinnitus, and fluctuant sensorineural hearing loss (SNHL), its presentation may limit initially to merely one or two of the above symptoms. Inability to obtain a fresh inner ear tissue leaves us to rely on hypothetical choices. Materials and Methods: Two adjuvants, glycerol test, and intratympanic gentamycin, were analyzed in our study, for their efficacy in diagnosing MD. Patients with symptoms of vertigo, tinnitus, and SNHL were evaluated. Those with presbycusis, conductive hearing loss (on pure tone audiogram [PTA]), benign paroxysmal positional vertigo (diagnosed by Dix Hallpike), retrocochlear pathology (short increment sensitivity index score below 70%), and central cause (magnetic resonance imaging angiography and neurology opinion) were excluded. Rest were subjected to glycerol test and subsequently intratympanic gentamicin. After a 6 month follow up, evaluation was performed for tinnitus and vertigo through a visual analog scale. Repeat PTA was done to look for any hearing deterioration due to gentamicin. Results: It was found that not only did glycerol positive patients get completely relieved of vertigo but also those who tested negative got completely or partially relieved of it. This shows a higher efficacy of intratympanic gentamycin as well as its significant association with glycerol test. Conclusion: This study lead us to form a strong diagnostic criterion which has already proven to be therapeutic in the management of MD.

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