Symptoms / Complaints

The so-called Menière’s triad, the occurrence of three typical symptoms in this disease, is composed of These symptoms improve after minutes to hours and occur repeatedly at irregular intervals. The patient does not know when and to what extent the next seizure will occur, which can lead to uncertainty and fear. Especially at the beginning of the disease, symptoms can also occur alone and not in the typical threefold pattern, so that the diagnosis of Meniere’s disease as a cause of e.g. rotary vertigo is difficult and may only be made in the further course of the disease. – sudden onset of rotational vertigo, in addition vomiting and nausea are possible (see: Vertigo due to diseases of the ear)

A unilateral ringing in the ears (tinnitus) and a dull feeling (“as if you had cotton wool in your ears”) and
A unilateral hearing loss for low tones (low frequency hearing loss).

Meniere’s diagnosis

A thorough medical history (anamnesis) and description of the signs (symptoms) of the disease is the most important basis in the diagnosis of Meniere’s disease. An exact diagnosis and an explanation of the disease that is comprehensible to the patient are important, so that the person affected is sufficiently informed about the disease and knows how to deal with the symptoms that arise. The symptoms of Menière’s disease are as follows: In the so-called interval, the time between Menière’s attacks, the patient does not suffer from rotational vertigo.

The symptoms tinnitus, feeling of pressure and low frequency hearing loss may be chronic and persist beyond the seizure. With regard to the hearing loss, a deterioration in the course of the seizure is often observed: While the hearing ability initially recovers and returns completely after the seizures, it is possible that the hearing ability is reduced or even deafness occurs even in the period without symptoms. The diagnostic guidelines state that Menière’s disease can only be diagnosed when at least two spontaneous attacks of rotational vertigo lasting at least 20 minutes have occurred, there is a ringing in the ears (tinnitus) with or without a feeling of pressure on the ear, and a hearing loss can be determined with audiometric tests (hearing test).

The following diagnostic methods are used to detect Meniere’s disease:

The glycerol test, also known as the Klockhoff test, is used to detect hydrops (fluid congestion) in the inner ear: The patient drinks a solution of glycerol (1.5 g of glycerol per kg of patient’s body weight), water in equal amounts and lemon juice. Glyerol (synonyms are propanetriol or propane-1,2,3-triol) is a trivalent alcohol and in Meniere’s disease it causes a temporary flushing out of the fluid congestion in the inner ear with an improvement in hearing. During the test, three audiograms (hearing curves/hearing test) are recorded: The patient’s hearing is tested 15 minutes before taking the glycerol-water mixture and 15 minutes and 120 minutes afterwards.

The test result is positive if the hearing ability is improved by the osmotic glycerol solution: the hearing threshold must decrease in at least three adjacent frequency ranges, which means that the patient can (better) perceive low sounds again. The understanding of monosyllabic words must improve by 10% so that the test can be considered positive. Positive means that the patient’s symptoms are most likely caused by Menièr’s disease.

The following diagnostic methods are used to detect Menière’s disease: The glycerol test, also known as the Klockhoff test, is used to detect hydrops (fluid retention) in the inner ear: The patient drinks a solution of glycerol (1.5 g of glycerol per kg of the patient’s body weight), water in equal amounts and lemon juice. Glyerol (synonyms are propanetriol or propane-1,2,3-triol) is a trivalent alcohol and in Meniere’s disease it causes a temporary flushing out of the fluid congestion in the inner ear with an improvement in hearing. During the test, three audiograms (hearing curves/hearing test) are recorded: The patient’s hearing is tested 15 minutes before taking the glycerol-water mixture and 15 minutes and 120 minutes afterwards.

In a temporary, acute attack, patients report rotational vertigo and describe it in a variety of ways, such as feeling “as if the ground is shaking” or “the environment is turning”. They are therefore very unsteady on their feet and have to throw up frequently. – In addition, there is a hearing loss / hearing impairment, which mainly relates to low frequency ranges (low frequency or bass hearing loss).

Rarely both ears are affected by this symptomatology. – The patient also reports a ringing in the ears (tinnitus) and a feeling of pressure on the affected ear. – As an accompanying symptom, the patient has a tremor of the eyes (nystagmus), which can be detected by the doctor when looking through special diagnostic glasses (Frenzel glasses).

Due to this eye tremor, the patient cannot fix his gaze on a fixed object, which increases his stability. Vegetative symptoms such as tachycardia or sweating may occur. Electrocochleography is an instrumental examination used to determine the presence of Menière’s disease.

This examination tests how well the hair cells of the hearing organ and the auditory nerve function. The hair cells are the sensory cells of the inner ear and are surrounded by endolymph. The sound waves that travel through the auditory canal to the middle ear cause the eardrum and subsequently the ossicles (hammer = malleus, ambos = incus and stapes = stirrup) to vibrate.

These oscillations cause the inner ear fluid to move in a wave-like motion and activate the hair cells. The activated auditory sensory cells convert the mechanical stimulus into electrical impulses, which are transmitted to the brain via the auditory nerve. In order to determine the stage of the disease in which the patient with Meniere’s disease is located, the patient is usually admitted to a hospital so that diagnosis and treatment can be tailored to the patient’s needs. Technical examinations such as an audiometric hearing test do not necessarily serve to diagnose Menière’s disease in the early stages of the disease, but help to exclude diseases with similar symptoms (differential diagnosis).