4
Diagnosis
Table 2. Key Definitions for Ménière's Disease (MD)
Guideline
Term Definition
Vertigo Sensation of self-motion (rotary spinning ) or movement of
the environment when neither is occurring or the sensation
of distorted self-motion (rotation or spinning ) during an
otherwise normal head movement
Imbalance Sense of unsteadiness, or instability; discrete from vertigo;
may be ongoing and not episodic
Acute MD attack Vertigo episode that lasts for 20 min to 12 hours and aural
symptoms (timing impacted by treatment onset)
Active MD Describes periods during which episodic acute attacks of MD
occur with some regularity
Definitive MD See Table 1
Drop attacks
(Tumarkin's
Otolithic Crisis)
Sudden fall associated with discrete MD attacks with no
warning ; the patient does not lose consciousness. Drop
attacks may be experienced during later stages of MD, and
they are not present in every patient.
Usable hearing Levels of adequate hearing perception oen defined by
the patient; may be audiometrically defined based on level
of hearing loss (HL), pure tone average (PTA) and word
recognition/discrimination scores (WRS) from vestibular
schwannoma literature:
AAO-HNS Scale:
Class A: Discrimination 70–100%; PTA <30dB
Class B: Discrimination 50–69%; PTA 31–50dB
Class C: Discrimination 50–69%; PTA >50 dB
Class D: Discrimination <50%; any PTA
Most clinicians consider Class A and B/C to be useable or
serviceable hearing ; Class D not considered serviceable
hearing
Probable MD See Table 1
PTA Pure Tone Average measured by audiometry
Hearing loss in MD Oen fluctuates from low- to mid-frequency but over time
may involve all frequencies
* Reprinted from Journal of Vestibular Research, Vol 19, Bisdorff A, Von Brevern M, Lempert T,
Newman-Toker DE, Classification of vestibular symptoms: towards an international classification
of vestibular disorders., 1-2, Copyright 2009, with permission from IOS Press.
