Ménière’s: why its diagnosis calls for more careful evaluation

DIFFICULTIES IN DIAGNOSING MÉNIÈRE’S

The triad of vertigo, tinnitus, and deafness is a familiar presentation in a GP surgery, but diagnosis and treatment remain a challenge. ‘Difficulty with everything in general practice is spotting the unusual from the commonplace, and continuity of care is really important’, says Dr Henrietta Hughes, GP and National Guardian for the NHS. ‘If a patient comes back to see several different people, they might all try something to fix the immediate problem rather than seeing the whole picture’ (personal communication, January 2017).

There is no definitive test for Ménière’s syndrome and it is not at all uncommon for people to be misdiagnosed. The classic symptoms are fluctuating hearing loss, low-pitch tinnitus, fullness in the ear, and episodic spinning vertigo that lasts at least 20 minutes, but typically 2–3 hours. (The whole attack should be over in less than 24 hours.) A number of recent studies examining the experiences of dizzy patients^1–3 have indicated that doctors frequently diagnose it when they see any vertigo they don’t understand, and there are patients diagnosed with Ménière’s syndrome who simply never get evaluated for anything else. Taking the history of a dizzy patient is essential to differentiate the possible aetiologies of vertigo, and a systematic approach must be used. The mnemonic ‘SO STONED’⁴ has been proposed, summarising the key factors that allow a first approximation of diagnosis identification: Symptoms, Often (frequency), Since, Trigger, Otology, Neurology, …