Commentary
2015 Equilibrium Committee
Amendment to the 1995 AAO-HNS
Guidelines for the Definition
of Ménière’s Disease
Otolaryngology–
Head and Neck Surgery
2016, Vol. 154(3) 403–404
Ó American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2016
Reprints and permission:
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DOI: 10.1177/0194599816628524
http://otojournal.org
Joel A Goebel, MD, FRCS1
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Abstract
Ménière’s disease is a disorder of the inner ear that causes
attacks of vertigo and hearing loss, tinnitus, aural fullness in
the involved ear. Over the past 4 decades, the Equilibrium
Committee of the AAO-HNS has issued guidelines for diagnostic criteria, with the latest version being published in
1995. These criteria were reviewed in 2015 by the
Equilibrium Committee, and revisions were approved at the
recent meeting of the committee at the 2015 AAO-HNSF
Annual Meeting. The following commentary outlines the
amended and approved criteria.
Keyword
Ménière’s disease diagnosis
Received December 21, 2015; accepted January 4, 2016.
M
énière’s disease (MD) was first described in 1861
by Prosper Ménière, and it consists of the clinical
combination of recurrent attacks of vertigo
accompanied by aural fullness, tinnitus, and fluctuating
hearing loss. Although no singular etiology for MD has
been discovered, the association of clinical symptoms
during life and the finding of endolymphatic hydrops on
postmortem temporal bone examination have led to the
view that the hearing loss and vertigo in MD are associated
with abnormal endolymph production and/or resorption.
Nevertheless, there remains no singular clinical test for MD,
and making the diagnosis rests with identification of key
clinical features.
In the past, numerous efforts have been made to produce
a consensus statement regarding the diagnosis of MD. In
1974, the Japanese Society for Equilibrium Research proposed criteria for diagnosing MD, which were not published. The American Academy of Otolaryngology—Head
and Neck Surgery (AAO-HNS) followed with a series of
published guideline statements in 1972, with subsequent
revisions in 1985 and 1995.1 At present, the AAO-HNS
recognizes 4 diagnostic categories for MD: certain, definite,
probable, and possible (Table 1). Moreover, the nature and
documentation of fluctuating hearing loss are broadly
defined.
Recently, the Barany Society has initiated an attempt to
develop internationally accepted definitions for a variety of
vestibular disorders. The Classification Committee of the
Barany Society was formed to develop the International
Classification of Vestibular Disorders to standardize terminology for reporting and research purposes regarding vestibular signs and symptoms, vestibular syndromes, and specific
vestibular diseases. With regard to MD, a multinational collaboration was formed among the Equilibrium Committee of
the AAO-HNS, the Japan Society for Equilibrium Research,
the European Academy of Otology and Neurotology, the
Korean Balance Society, and the Barany Society to further
refine the definition of MD and explore potential etiologies.
Under the direction of Jose A. Lopez-Escamez, MD, PhD, a
consensus document was created on published in 2015.2 This
document outlines the committee’s recommendations with
regard to diagnostic criteria for MD and discusses potential
etiologies and associations with alternative diagnoses, including vestibular migraine and transient ischemia. In this document, only 2 categories of MD—definite and probable—are
recognized and the characteristics of each category defined
(Table 2). At the 2015 AAO-HNSF Annual Meeting in
Dallas, the Equilibrium Committee reviewed and approved
the modified definitions of MD as an amendment to the 1995
MD guidelines. The major differences between the new and
old definitions are as follows: (1) the elimination of the ‘‘certain’’ and ‘‘possible’’ MD categories, (2) the requirement for
audiometrically documented low- to mid-tone fluctuating loss
1
AAO-HNS Equilibrium Committee, Department of Otolaryngology–Head
and Neck Surgery, Washington University School of Medicine, Saint Louis,
Missouri, USA
Corresponding Author:
Joel A. Goebel, MD, FRCS, Chairman, AAO-HNS Equilibrium Committee,
Department of Otolaryngology–Head and Neck Surgery, Washington
University School of Medicine, 660 South Euclid, Campus Box 8115, Saint
Louis, MO 63110, USA.
Email: [email protected]
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404
Otolaryngology–Head and Neck Surgery 154(3)
Table 1. 1995 AAO-HNS Guidelines for Diagnosis of Ménière’s Disease.1
Certain
Definite
Definite Ménière’s disease, plus histopathologic confirmation of hydrops
Two or more definitive spontaneous episodes of vertigo 20 min or longer
Audiometrically documented hearing loss on at least 1 occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded
One definitive episode of vertigo
Audiometrically documented hearing loss on at least 1 occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded
Episodic vertigo of the Ménière’s type without documented hearing loss or
Sensorineural hearing loss, fluctuating or fixed, with disequilibrium but without definitive episodes
Other causes excluded
Probable
Possible
Table 2. Amended 2015 Criteria for Diagnosis of Menière’s Disease.
Definite
Probable
Two or more spontaneous episodes of vertigo, each lasting 20 min to 12 h
Audiometrically documented low- to midfrequency sensorineural hearing loss in 1 ear, defining the affected
ear on at least 1 occasion before, during, or after 1 of the episodes of vertigo
Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
Not better accounted for by another vestibular diagnosis
Two or more episodes of vertigo or dizziness, each lasting 20 min to 24 h
Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
Not better accounted for by another vestibular diagnosis
in the affected ear only in the ‘‘definite’’ category, and (3) a
defined range of vertigo duration. The committee did not
address additional topics in the International Classification of
Vestibular Disorders document regarding etiology or therapy
and felt that a more thorough review of the entire disease
process via a clinical practice guideline would be more
appropriate.
Author Contributions
Joel A Goebel, complete authorship.
Sponsorships: Equilibrium Committee, American Academy of
Otolaryngology—Head and Neck Surgery.
Funding source: None.
References
1. Committee on Hearing and Equilibrium. Guidelines for the diagnosis and evaluation of therapy in Menière’s disease. Otolaryngol
Head Neck Surg. 1995;113:181-185.
2. Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Ménière’s disease. J Vestib Res. 2015;25;1-7.
Disclosures
Competing interests: Joel A. Goebel, Micromedical Technologies—
speaker’s bureau, honoraria; Lippincott Williams & Wilkins, Practical
Management of the Dizzy Patient—book royalty.
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