Meniere’s Disease: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height.
• ENT medical examination – including inspection of the external ear and auditory canal; otoscopy (ear examination) tuning fork tests according to Weber and Rinne, to differentiate between middle ear and sensorineural hearing loss:
  • According to Weber (Weber test): procedure: the foot of a vibrating tuning fork is placed on the crown of the patient’s head. The sound is transmitted in phase to both inner ears via bone conduction. Normal hearing: Sound from the tuning fork heard equally in both ears (in the middle of the head), sound is not lateralized (lat. latus = side). Unilateral or asymmetric hearing disorder: tone of the tuning fork on one side, it is called “lateralization” (lateralization).
    • Unilateral sensorineural hearing loss: the sound is perceived louder by the better hearing (normal) inner ear (patient lateralizes to the healthy ear) [sensorineural hearing loss].
    • Unilateral sound conduction disorder: the sound is heard louder in the diseased ear
  • According to Rinne (Rinne experiment): the Rinne experiment takes advantage of the physiological properties of the ear: If the patient has normal hearing, sound is perceived louder via air conduction than via bone conduction because of the amplification properties of the ossicles and eardrum. A decaying tuning fork (tuning fork foot on the bone process behind the auricle), which is no longer heard via bone conduction, is heard longer via air conduction (tuning fork in front of the auricle). Procedure: A vibrating tuning fork is first placed on the patient’s bony process behind the auricle (“mastoid”, lat. Processus mastoideus) with the tuning fork foot. As soon as the patient gives a sign that he no longer hears the tuning fork, it is held directly in front of his auricle.
    • Rinne test positive: the patient can still hear the tuning fork → there is no sound conduction disturbance, but a sound sensation disturbance is not excluded with it.
    • Rinne test negative: The patient no longer hears the tuning fork → conductive hearing loss (= disorder in the outer or middle ear area).
    • If the patient credibly states not to perceive any tuning fork sound at all, a pronounced sensorineural hearing loss of both ears must be present.
• If necessary, neurological examination [due todifferential diagnoses:
  • Multiple Sclerosis (MS)
  • Neuronitis vestibularis – inflammation of the vestibular nerve leading to disturbance of the vestibular organ with acute vertigo and vomiting
  • Subclavian steal syndrome (vertebral artery tap syndrome) – belongs to the so-called tapping phenomena (steal syndromes) and refers to blood pressure drops or fluctuations distal to transient or incomplete stenosis of the subclavian artery even before the departure of the vertebral artery
  • Vertebrobasilar insufficiency – decreased blood flow through the vertebral artery and basilar artery.
  • Wallenberg syndrome (synonyms: Brainstem syndrome, Dorsolateral medulla-oblongata syndrome or Arteria-cerebellaris-inferior-posterior syndrome; English PICA syndrome) – special form of apoplexy.
  • Cerebral circulatory disorders, unspecified]
• If necessary, orthopedic examination [due todifferential diagnosis: cervical syndrome – syndrome of the cervical spine with nerve compression / damage].
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.