Investigations

To exclude systemic conditions.

• renal function, glucose - metabolic disturbances
• FBC, ESR, CRP - infections
• TFT - hormonal imbalances (1)

For testing of hearing

• pure tone audiometry:
  • to assess the level of hearing loss
  • initially, low frequencies are lost whihch resolves after an attack
  • later, loss of higher frequencies occurs, causing a more flattened audiogram
  • typically indicates a sensory type of hearing loss in the affected ear
  • speech discrimination is often diminished in the affected ear

For testing of balance

• ENG (electronystagmograph) or video nystagmography
  • may be performed to evaluate balance function
  • procedure:
    • it is done in a darkened room
    • recording electrodes are placed near the eyes
    • warm and cool water or air are gently introduced into each ear canal
    • measurement of eye movements is used to test the balance system
    • in about 50% the balance function is reduced in the affected ear.
• rotational testing (balance platform)

In addition, patients who are suspected of having Meniere's disease, should rule out acoustic neuroma (vestibular schwannoma) by having a magnetic resonance imaging of the internal auditory meatus.

Other tests which are used in specialist clinics include:

• the bithermic caloric testing an objective test of unilateral peripheral vestibular disease
• ectrocochleography (ECoG) – measures the electrical activity of the inner ear
• the vestibular evoked myogenic potential -
• the video head-impulse test- to identify peripheral vestibular deficits

Reference:

• (1) Leong S. Clinical Review - Ménière's disease. GPOnline 2011
• (2) Harcourt J, Barraclough K, Bronstein AM. Meniere's disease. BMJ. 2014;349:g6544
• (3) Medical content of the american academy of otolaryngology−head and neck surgery. Ménière's disease.2008