5
Table 3. Summary of Key Action Statements (KAS)
Statement Action Grade
1. Diagnosis of
Ménière's Disease
Clinicians should diagnose definite or
probable Ménière's disease in patients
presenting with two or more episodes of
vertigo lasting 20 minutes to 12 hours
(definite) or up to 24 hours (probable)
and fluctuating or non-fluctuating
sensorineural hearing loss, tinnitus or
pressure in the affected ear, when these
symptoms are not better accounted for
by another disorder.
Recommendation
2. Assessing for
Vestibular Migraine
Clinicians should determine if patients
meet diagnostic criteria for vestibular
migraine when assessing for Ménière's
disease.
Recommendation
3. Audiometric
Testing
Clinicians should obtain an audiogram
when assessing a patient for the
diagnosis of Ménière's disease.
Strong
Recommendation
4. Utility of Imaging Clinicians may offer magnetic resonance
imaging (MRI) of the internal auditory
canal (IAC) and posterior fossa in
patients with possible Ménière's disease
and audiometrically verified asymmetric
sensorineural hearing loss.
Option
5. Vestibular or
Electrophysiologic
Testing
Clinicians should not routinely
order vestibular function testing or
electrocochleography to establish the
diagnosis of Ménière's disease.
Recommendation
Against
6. Patient Education Clinicians should educate patients with
Ménière's disease about the natural
history, measures for symptom control,
treatment options, and outcomes.
Recommendation
7. Symptomatic
Management of
Vertigo
Clinicians should offer a limited course
of vestibular suppressants to patients
with Ménière's disease for management
of vertigo only during Ménière's disease
attacks.
Recommendation
8. Symptom
Reduction and
Prevention
Clinicians should educate patients
with Ménière's disease on dietary and
lifestyle modifications that may reduce
or prevent symptoms.
Recommendation
9. Oral
Pharmacotherapy
for Maintenance
Clinicians may offer diuretics and/or
betahistine for maintenance therapy to
reduce symptoms or prevent Ménière's
disease attacks.
Option
