Editing Ménière's disease (section)

== Diagnosis ==
[[File:Menieres-hearing-loss.png|thumb|right|upright=1.4|[[Audiogram]]s illustrating normal hearing (left) and unilateral low-pitch hearing loss associated with Ménière's disease (right)]]
[[File:LDL-Audiogram.jpg|thumb|Loudness discomfort levels (LDLs) – data of people with hyperacusis without hearing loss. Upper line: average hearing thresholds. Lower long line: LDLs of this group. Lower short line: LDLs of a reference group with normal hearing.<ref name="pmid26029161">{{cite journal | vauthors = Sheldrake J, Diehl PU, Schaette R | title = Audiometric characteristics of hyperacusis patients | journal = Frontiers in Neurology | volume = 6 | pages = 105 | year = 2015 | pmid = 26029161 | pmc = 4432660 | doi = 10.3389/fneur.2015.00105 | doi-access = free }}</ref>]]

The diagnostic criteria as of 2015 define definite MD and probable MD as:<ref name=Con2015/><ref name=See2016/>

<blockquote>'''Definite'''
# Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
# Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least one occasion before, during, or after one of the episodes of vertigo
# Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
# Not better accounted for by another vestibular diagnosis
'''Probable'''
# Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours
# Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the reported ear
# Not better accounted for by another vestibular diagnosis</blockquote>

A common and important symptom of MD is [[hyperacusis|hypersensitivity to sounds]].<ref name="Ruckenstein 2010 p. ">{{cite book | editor1-last=Ruckenstein | editor1-first=Michael | title=Ménière's disease: evidence and outcomes | publisher=Plural Publishing, Inc | location=San Diego, California Abingdon, England | year=2010 | isbn=978-1-59756-620-9 | page=34|chapter=Chapter 6: Clinical Presentation of Ménière's disease|last1=Chi|first1=John J.|last2=Ruckenstein|first2=Michael J.}}</ref> This hypersensitivity is easily diagnosed by measuring the loudness discomfort levels (LDLs).<ref name="pmid25104073">{{cite journal | vauthors = Tyler RS, Pienkowski M, Roncancio ER, et al. | title = A review of hyperacusis and future directions: part I. Definitions and manifestations | journal = American Journal of Audiology | volume = 23 | issue = 4 | pages = 402–419 | year = 2014 | pmid = 25104073 | doi = 10.1044/2014_AJA-14-0010 | url = http://www.hyperacusis.net/media/1375/hyperacusis-part-1.pdf | access-date = 19 October 2017 | archive-date = 27 June 2017 | archive-url = https://web.archive.org/web/20170627223134/http://www.hyperacusis.net/media/1375/hyperacusis-part-1.pdf | url-status = dead }}</ref>

Symptoms of MD overlap with [[migraine-associated vertigo]] (MAV) in many ways, but when hearing loss develops in MAV, it is usually in both ears, and this is rare in MD, and hearing loss generally does not progress in MAV as it does in MD.<ref name=Con2015/>

People who have had a [[transient ischemic attack]] (TIA) or [[stroke]] can present with symptoms similar to MD, and in people at risk [[magnetic resonance imaging]] <!-- (MRI) --> should be conducted to exclude TIA or stroke.<ref name=Con2015/>

Other vestibular conditions that should be excluded include [[vestibular paroxysmia]], [[recurrent unilateral vestibulopathy]], [[vestibular schwannoma]], or a tumor of the [[endolymphatic sac]].<ref name=Con2015/>