Making a diagnosis in patients who present with vertigo

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5809 (Published 03 September 2012) Cite this as: BMJ 2012;345:e5809

Re: Making a diagnosis in patients who present with vertigo

Dear Sir,

We read with interest the article ‘Making a diagnosis in patients who present with vertigo’1 and applaud Kaski and Bronstein’s explanation regarding both the differential diagnosis of vertigo and the emphasis that ‘not all vertigo is labyrinthitis’.

However we feel that to ensure the article is comprehensive, reference to the overdiagnosis of Meniere’s disease should be made. Similar to the diagnosis of labyrinthitis for patients with vertigo, Meniere’s disease is often a diagnosis given to a patient with vertigo and any hearing loss. Indeed, anecdotally many patients are referred to hospital with a history of Meniere’s for many years when in fact they have another pathology altogether.

Almost 150 years after its first description, the diagnosis of Meniere´s disease is still challenging. It is defined as recurrent, spontaneous episodic vertigo, hearing loss, aural fullness and tinnitus and according to the AAO-HNS (American Academy of Otolaryngology and Head and Neck Surgery)2, all of these have to meet specific criteria. Serial pure tone audiograms demonstrating a sensorineural hearing change and a magnetic resonance imaging scan of the internal auditory meatii to exclude central pathology are essential in order to reach a diagnosis of Meniere’s disease.

We would therefore suggest such patients be referred to appropriate specialist units in order to confirm a clinical suspicion and
institute appropriate treatment.

1. Kaski D, Bronstein AM. Making a diagnosis in patients who present with vertigo: Not all vertigo is labyrinthitis. BMJ 2012;345:e5809
2. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease.American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg. 1995 Sep;113(3):181-5.

Competing interests: No competing interests

17 September 2012
Nicholas E Gibbins
Specilist Registrar Otolaryngology
Rahul Kanegaonkar (consultant otolaryngology, Guy's and St. Thomas' Hospital NHS Foundation Trust)
Royal Sussex County Hospital
Eastern Road, Brighton. BN2 5BE.