Ménière’s disease/syndrome

It is not at all uncommon for SCDS patients to be misdiagnosed with Ménière’s disease. A number of recent studies, examining the experiences of dizzy patients, have indicated that doctors frequently diagnose it when they see any vertigo they don’t understand. The classic symptoms of Ménière’s syndrome are fluctuating hearing loss, low pitch tinnitus, fullness in the ear and episodic spinning vertigo which lasts at least 20 minutes, but typically two to three hours. (The whole attack should be over in less than 24 hours.)

When considering Ménière’s, it is important to distinguish between Ménière’s disease, when the cause cannot be identified (idiopathic in other words), and Ménière’s syndrome, when it is secondary to another disorder. Treating the underlying cause often resolves the Ménière’s syndrome with much greater success than the non-specific treatments employed for Ménière’s disease. A drug that works for one person does not necessarily work for another because the underlying reasons for the syndrome are so varied and the complex pharmacokinetics of the inner ear make drug delivery to it a tricky business.

The data from a number of recent studies suggest that the diagnosis of Ménière’s disease is over-utilised, and also that there are patients with Ménière’s syndrome who simply never get evaluated for anything else.  If the patient has only had one vertigo attack, it may be because of an inner ear infection, and a diagnosis of Ménière’s disease should not be given unless multiple attacks have occurred.

In recent years it has become apparent that many patients whose Ménière’s symptoms have been considered idiopathic are in fact suffering from SCDS. Doctors should carefully consider other possibilities, SCDS among them, when a patient presents with the Ménière’s triad of hearing loss, vertigo and tinnitus, particularly if the clinical features are severe and persistent. In this situation, they should not hesitate to refer for specialist assessment, and a high resolution CT scan would be required to identify SCDS.