Scenario: A 38-year-old male clerk saw his doctor because of sudden episodes of nausea and dizziness. These attacks had started 3 weeks earlier and seemed to be getting worse. The abnormal episodes at first lasted only a few minutes, during which “the room seemed to spin.” Lately, they had been lasting for many hours. A severe attack caused the patient to vomit and to hear abnormal sounds (ringing, buzzing, paper-rolling sounds) in the left ear. He thought that he was becoming deaf on that side.

The neurologic examination was within normal limits except for a slight sensorineural hearing loss in the left ear. Computed tomography (CT) examination of the head was unremarkable.

Question: What three criteria define the diagnosis of Meniere Disease? Does this patient demonstrate all three?

Potential answers:

A. Vertigo, migraine, dysmetria

B. Vertigo, hearing loss, and tinnitus with ear pressure.

C. Migraine, diplopia, hearing loss

D. Tinnitus, nystagmus, general weakness

Answer with rationale: B. Vertigo, hearing loss, and tinnitus with ear pressure.

According to the American Academy of Otolaryngology, with Meniere Disease will present with vertigo lasting a minimum of 20 minutes for at least 2 episodes.

Hearing loss must be audiometrically documented for at least one episode.

Tinnitus will be present in the patient, with fullness of the ear or ear pressure as well.

Nystagmus is commonly weak, positional, and direction changing when exhibited with Meniere Disease.

Migraine, dysmetria, diplopia, and general weakness are not seen as signs of Meniere Disease.

For more Information see Chapter 261 Meniere Disease in The Color Atlas of Physical Therapy