Clinical Practice Guideline

Menière’s Disease

(Endorsed, April 2020)

The “Clinical Practice Guideline: Menière’s Disease” was developed by the American Academy of Otolaryngology-Head and Neck Surgery and endorsed by the American Academy of Family Physicians.

Key Recommendations

Individuals presenting with two or more episodes of vertigo lasting 20 minutes to 12 hours (definite) or up to 24 hours (probable) in addition to fluctuating hearing loss, tinnitus or pressure in the affected ear, should be diagnosed with definite or probable Menière’s disease when presenting symptoms are not better accounted for by another disorder.
Individuals who are assessed for Menière’s disease should also be evaluated for vestibular migraine.
An individual should receive an audiogram when assessed for the diagnosis of Menière’s disease.
MRI of the internal auditory canal and posterior fossa may be offered to patients with possible Menière’s disease and audiometrically verified asymmetric sensorineural hearing loss.
Vestibular function testing or electrocochleography should not routinely be used to establish the diagnosis of Menière’s disease.
Individuals with Menière’s disease should receive counseling about the natural history of the disease, measures for symptom control, treatment options, and outcomes.
A limited course of vestibular suppressants should be offered to patients for management of vertigo only during Menière’s disease attacks.
Diuretics and/or betahistine should also be offered for maintenance therapy to reduce symptoms or prevent Menière’s disease attacks.
Positive pressure therapy should not be offered as treatment for individuals with Menière’s disease.
Intratympanic steroids may be offered to individuals with active Menière’s disease who are not responsive to non-invasive treatment.
Intratympanic gentamicin should be offered to individuals with active Menière’s disease who are not responsive to non-ablative therapy.
Labyrinthectomy should be offered to individuals with active Menière’s disease who have failed less definitive therapy and have non-usable hearing.
Vestibular rehabilitation/physical therapy should be offered to individuals with Menière’s disease to manage chronic imbalance but not to manage acute vertigo attacks.
Individuals with Menière’s disease and band hearing loss should receive counseling on the use of amplification and hearing assistive technology.

More About Practice Guidelines

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.