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Meniere’s Disease Diagnosis and Testing

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How Meniere’s Disease is Diagnosed, How They Test for it and What They are Looking for to Confirm the Diagnosis.

It is very important to get a correct Meniere’s disease diagnosis for your symptoms, therefore you need to rule out other possible problems or causes. When you are finally given a diagnosis it means that certain medical criteria will have been met.

How Do The Specialists Come Up With A Meniere’s Disease Diagnosis?

There is an established “formula” to which your Meniere’s disease symptoms and the results are compared. They will either match this formula through all the testing, or not. In some cases, if hearing is not involved, the Meniere’s disease diagnosis could be Benign Positional Paroxysmal Vertigo (BPPV). Here only the balance nerve is involved.

Most of the time, the reason for the testing is the same: to RULE out any pathology.

All of this testing requires a very detailed history and physical examination. It also includes visits to different specialists and facilities, all specializing in different knowledge and technologies. This is done to collect all the test components to come up with a correct Meniere’s disease diagnosis.

More than likely, you will be sent to one or more specialists: an otolaryngologist (an ear, nose, and throat specialist commonly referred an ENT). Depending on your doctor’s thoughts, you may be referred to a neurologist (brain), and often to an audiologist (hearing).

The eyes, ears, and brain are in close proximity. In fact, for a proper Meniere’s disease diagnosis, your entire body is involved. Tests using several technologies will be ordered.

Overall, this testing process to come up with an accurate diagnosis requires several visits and time to do the different procedures, await the results, and then go back for another consultation to have everything explained.

A Detailed Diagnosis History for Meniere’s Disease:

Your general practitioner can do this physical exam and take the history. In your details, you will need to describe what happens when you have a Meniere’s disease attack and what you were doing before you had the attack. It really helps to have this written down, if you are able to do this after the attack passes.

Sometimes you will be too exhausted, or too confused to be able to do this right away. Even if you write down what you remember when you are able to, this is still better than trying to remember everything a few (many?) days later in the doctors office, or emergency.

Better still, give your doctor a copy of your written description of the attack. This helps your doctor(s) eliminate some conditions fairly quickly and you get a faster diagnosis so you can work on getting relief from your symptoms more quickly.

They will need a history of the frequency, duration, severity, and character of your Meniere’s disease symptoms and attacks, the duration of hearing loss and whether it has been changing for your diagnosis to be as accurate as possible.

Each individual’s case must be checked against the possible cause of middle ear infections (otitis media) or head injury.

Other risk factors include:

  • recent viral infections
  • respiratory infections
  • stress
  • fatigue
  • use of prescription or nonprescription drugs including aspirin
  • a history of allergies, smoking, and alcohol use

In order for the doctor to know if you actually have Meniere’s disease, they have to eliminate some common medical conditions to come up with a correct diagnosis.

You will be asked if you have any history of:

Before you go in to be tested for Meniere’s disease, it is a good idea to be prepared with lots of notes about your thoughts and experiences of your symptoms and attacks. It is much easier to “recall” medical events when your doctors are asking you questions if you have already spent some time mulling them over and writing them down.

A physical examination of the ears and other structures of the head and neck will be done, but these findings are usually normal, except during an episode or an attack.

How to diagnose Meniere’s disease

Some of the most common tests used for diagnosing Meniere’s disease will include

  • MRI
  • Audiometric Testing (Hearing) Electronystagmography (ENG)
  • Transtympanic electrocochleography (ECOG)

There are other tests available such as an EEG (electroencephalogram) and others. But these are the basics to rule out any other problems.

Specialists have access to the latest scientific information and testing and they are able to come up with pretty accurate methods for a diagnosis. The results you want to hear are that “this is within normal values” or “everything is normal”. Then you know all is well physically in your body.

Once all the testing is complete and the specialists’ visits are done, you want to visit the “main” consultant to hear what their impression is.

One thing you may want to keep in mind when you are talking with the Doctor is that often the terms “Endolymphatic Hydrops” or ‘Hydrops” are used interchangeably to describe Meniere’s disease. Sometimes medical personnel use other terms. Make sure you ask if something isn’t clear.

I want to explain the phrase “electro” that precedes so many of these medical terms. We are dealing with nerves. Nerves deal with electrical impulses and how your body automatically responds with them. “Electro” reflects that electrical impulse. So again, the tests are there to prove your body is functioning normally.

Some of the most common tests used for diagnosing Meniere’s disease:

These tests will rule out any other medical conditions that could be confused for Meniere’s disease and they will measure your present level of hearing and balance.

Test: Magnetic Resonance Imaging “MRI”

It provides detailed pictures of brain and nerve tissues from multiple layers without obstruction by any protective bone.

What will the MRI test tell you?

MRI is the procedure of choice for most brain disorders because it can clearly show various types of nerve tissue. It provides clear pictures. It is noninvasive, meaning it doesn’t hurt and nothing cuts into your body and you are not exposed to any radiation. It is all done using modern computer technology. It can evaluate blood flow and the flow of cerebrospinal fluid (CSF). An MRI can show tumors or abnormal lesions from normal tissues.

How the MRI test is performed;

The MRI scanner is in a special area that has been shielded from outside magnetic fields (so as not to interfere with your results). You lie on a narrow table that can slide inside a large tunnel-like tube within the tube-like scanner. This scanner creates a magnetic field around you, and then directs radio waves at the tissues it is evaluating.

Several sets of images are usually required, each taking from 2 to 15 minutes. The complete scan takes about 1 hour; although some scans take more than 90 minutes. This test will not cause any discomfort, but some people feel a little shut in. and there is a noise coming from the machine itself.

An MRI test for Meniere’s disease is done to rule out any abnormal physical conditions in your head. This is a physical image, a picture of the actual tissue. You might also get a middle ear MRI test for Meniere’s disease.

Test : Transtympanic electrocochleography (ECOG Test)

The cochlea is a snail-shaped bony structure in the inner ear and deals with balance.

What will the ECOG test tell you?

The test measures the inner ear pressure, specifically in the cochlea. The results may indicate increased inner ear fluid pressure. Too much pressure can affect your balance. Increased fluid pressure puts added weight and bulk to the natural cochlear activity including surrounding tissue. “Inner ear pressure” is one of the criteria used in arriving at a correct diagnosis of Meniere’s disease. The test gives specific readings.

How the ECOG test is performed;

A special tiny sterile electrode tube is placed close to the eardrum to measure the pressure.

Why is the ECOG test done?

It is done to check and record the fluid pressure of the cochlea.

Test: Electronystagmography “ENG”. There also another test called the Caloric test. It is very similar to the ENG test, but is done slightly differently.

What will the ENG test tell you?

The ENG test will measure eye movements and eye nerve reactions to warm and cool water or air applications. (This test may be done in relation to balance nerve symptoms.)

How the ENG test is performed

Small electrodes are gently attached to several positions on the skin along the outer sides of your eyes. (There are several ways of attaching these measuring devices.) Once they are in place, warm and cool water (and sometimes air) are instilled into the ear canal.

The recording device notes all the changes happening with your eyes as this is done. This same process can also be done “manually” with visual notes. That is the caloric test and the caloric testing results will be similar to the ENG testing results.

Why is the ENG test done?

It is done to check the “nerve reaction” as shown by eye movements. Both the ENG test and the CALORIC TEST have to do with certain eye movements. With Meniere’s Disease, a certain recognized pattern known as nystagmus is looked for. It is a quick side by side eye movement that comes from the water (or air) application.

Hearing Tests: Audiology is the study of hearing. All the testing will have specific purposes.

  • Audiometry: “audio” means sound. So “Audiometry” (measures the sound, ability to hear.)
  • Audiogram (plots the sound on a graph)
  • Audiography is another name for Audiometry.

What will the hearing tests will tell you?

These tests measure your hearing ability: what sounds and the amount of sound you hear. There are several different tests: each is done for a very specific purpose.

An audiometric examination typically indicates a sensory type of hearing loss in the affected ear. The ability to distinguish “sit” and “fit” is often impaired in the affected ear. (“Speech discrimination”)

Part of the basic criteria for a correct diagnosis is “hearing fluctuation”. Therefore it is very helpful to have precise historical documentation.

How the hearing tests are performed;

You are attached to a variety of machines that collect different information. Often special “computerized” headphones are used. Some technology will record what you hear while other information will be captured on a graph to be printed out. While most of this is done through the use of headphones, some testing is also done by measuring hearing conduction BEHIND the ear.

Why are the hearing tests done?

To create a record of your hearing ability.

Test: Electroencephalogram (EEG)

What will the EEG test tell you?

It helps to diagnose the presence and type of seizure disorders, head injuries, brain tumors, infections, degenerative diseases, and metabolic disturbances that all could affect the brain. This will give you a more accurate diagnosis by identifying some conditions that may cause similar symptoms to Meniere’s disease.

If you pretend that the brain is the management group of your body, you will appreciate that it has to be healthy. This shows you its current health state. The EEG tests the physical and anatomical performance of your brain.

Incidentally the procedure cannot be used to “read the mind,” measure intelligence, or diagnose mental illness. (But with the amazing scientific advances today, there are tests that can do that.)

How the EEG test is performed

You will have special electrodes applied with glue to your head. It is not necessary to shave your head in most cases, but you do want to ask if you need to do anything out of the ordinary in preparation for this test. Otherwise you will need to lie still as the scanner takes picture of at different parts of your brain.

Why is the EEG test done?

This will provide a graph, (visual) record of your brain’s electrical activity

There are other tests available to support a correct Meniere’s disease diagnosis, but the tests listed above are the most common ones.

IN SUMMARY

Testing for Meniere’s disease is a way to rule out any other potential problem(s). There is no test to say ”you have Meniere’s Disease”. There are normal values or standards for all tests.

As each test is completed, a specialist will then compare your test results to these “normal” values. These results will then be forwarded to the specialist who ordered the tests, most likely the ENT. Your own doctor often gets a copy for your files.

  • If you would like a copy of our Meniere’s Disease Study Guide, please click here.  This guide is a step by step journey exploring your symptoms and what may be causing them.
  • If you would like more information on the system that David, and numerous others, have used, please click here; What Finally Worked.
  • If you have any health questions or concerns, please feel free to Contact Us and we will be happy to share our knowledge and ideas with you.

Karin Henderson, Retired Nurse

(604) 463-8666 – Pacific Standard Time