Intended for healthcare professionals

Clinical Review

Meniere’s disease

BMJ 2014; 349 doi: (Published 12 November 2014) Cite this as: BMJ 2014;349:g6544
  1. Jonny Harcourt, consultant otologist1,
  2. Kevin Barraclough, general practitioner2,
  3. Adolfo M Bronstein, professor of clinical neuro-otology3
  1. 1Charing Cross Hospital, London, UK
  2. 2Hoyland House, Painswick, Gloucestershire
  3. 3Imperial College London, London, UK
  1. Correspondence to: J Harcourt jonnyharcourt{at}

The bottom line

  • Meniere’s disease is a rare cause of new onset vertigo compared with more common conditions such as benign paroxysmal positional vertigo or vestibular migraine

  • Pure tone audiometry is the most useful diagnostic test for Meniere’s disease

  • Although Meniere’s disease has no definitive cure, medical management and in some cases intratympanic ablation using gentamicin considerably reduces symptoms and disability from the condition

  • Open surgery should be a rare option for the condition

  • Rehabilitation of audiovestibular loss is important and many patients may require psychological support

Meniere’s disease is often considered in the differential diagnosis of episodic dizziness, although it is not a common cause of new onset vertigo. Rather it is a disorder of the inner ear, characterised by recurrent attacks of self limiting vertigo. These attacks are associated with unilateral fluctuating low frequency sensorineural hearing loss, a sense of “fullness” in the affected ear (aural fullness), and tinnitus.1 Clinical findings are initially normal between attacks but later there is unilateral hearing loss and tinnitus. Treatment of the condition has not been evidence based in the past, but new treatments look promising.

In this article we discuss what is known about the pathogenic process of Meniere’s disease and consider the clinical presentation of the disease, its clinical course and prognosis, and what clinical features help to discriminate the condition from other diagnoses. We also examine the evidence for treatment.

Sources and selection criteria

We carried out a search of Medline for systematic reviews in the Cochrane Collaboration and Clinical Evidence from 1966-2013 using the key words “Meniere’s disease”, “inner ear”, “treatment”, “vertigo”, and “hearing loss”. We also base this review on the extensive experience of two of the authors (JH and AMB) in assessing and treating patients with the Meniere’s disease.

What is Meniere’s disease?

Meniere’s disease was first described by Prosper Meniere, a French doctor who worked …

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