• Vertigo: a spinning sensation, often with nausea or vomiting
• Fluctuating hearing loss, usually in one ear initially
• Tinnitus: ringing, roaring, or buzzing in the ear
• A feeling of pressure or fullness in that ear

Diagnosis

Treatment

• During attacks: anti-nausea and vestibular-suppressant medicines prescribed by a clinician
• Preventive measures: reducing dietary salt, avoiding personal triggers such as alcohol or excess caffeine, good sleep and stress management
• Some patients: diuretics
• Persistent severe one-sided vertigo: ENT-directed treatments such as intratympanic steroid injections, intratympanic gentamicin, or selected surgery. Gentamicin can reduce vertigo but may worsen hearing. NIDCD treatment overview

Latest clinical guideline

• [Practice Guideline . Tier 6 . 2020] Basura et al. Clinical Practice Guideline: Ménière’s Disease. Otolaryngology-Head and Neck Surgery. PMID: 32267799
• The official AAO-HNS guideline page provides the full guideline, executive summary, and patient materials.

Core AAO-HNSF recommendations

Diagnosis and testing

1. Diagnose definite or probable Ménière’s disease in people with at least 2 episodes of vertigo lasting:
   • 20 minutes to 12 hours for definite disease
   • 20 minutes to 24 hours for probable disease
     with sensorineural hearing loss, tinnitus, or ear pressure/fullness that cannot be better explained by another disorder.
2. Specifically assess for vestibular migraine, an important alternative or coexisting diagnosis.
3. Obtain an audiogram when assessing suspected Ménière’s disease.
4. MRI of the internal auditory canals/posterior fossa may be offered when there is audiometrically verified asymmetric sensorineural hearing loss, principally to exclude an alternative lesion.
5. Do not routinely order vestibular-function testing or electrocochleography solely to establish the diagnosis.

Education and conservative management

1. Explain the natural history, symptom-control measures, treatment choices, and likely outcomes.
2. Counsel on dietary and lifestyle measures that may reduce or prevent attacks. The guideline does not prescribe one universal diet, but clinicians commonly individualize reduction of salt intake and identify triggers.
3. Use a short, limited course of vestibular suppressants only during acute vertigo attacks, not as continuous long-term therapy.
4. Diuretics and/or betahistine may be offered as maintenance therapy to reduce or prevent attacks. This is an option, meaning the evidence is less definitive than for stronger recommendations.

Escalation for active or refractory disease

1. If noninvasive treatment has not controlled active disease:

• Intratympanic corticosteroids may be offered.
• Intratympanic gentamicin should be offered when symptoms remain active despite non-ablative therapy. It can control vertigo but has risk to hearing and vestibular function, so it requires specialist counselling.

1. Do not prescribe positive-pressure therapy for Ménière’s disease.
2. Labyrinthectomy may be offered only for active disease that has not responded to less definitive treatments and where hearing in the affected ear is already non-usable.

Rehabilitation and hearing care

1. Offer vestibular rehabilitation/physical therapy for chronic imbalance, but not for acute vertigo attacks.
2. Counsel and refer as appropriate for hearing amplification and assistive listening technology when hearing loss affects function.

Other guideline