In a recent editorial, Halmagyi and Cremer consider Menière's disease in their discussion of recurrent spontaneous vertigo.1 Menière's disease is a diagnosis of exclusion. Many conditions may present with the triad of hearing loss, vertigo, and tinnitus, most importantly vestibular schwannomas.2 Gadolinium enhanced MRI imaging is the current gold standard for diagnosing vestibular schwannoma and is mandatory before giving somebody the diagnosis of Menière's disease. The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery have set out guidelines for the diagnosis and evaluation of therapy in Menière's disease.3

Audiovestibular testing can be useful in Menière's disease. Caloric testing has poor sensitivity and specificity in diagnosing the disease. Electrocochleography and glycerol dehydration testing can be useful in the earlier stages of the disease before the hearing function is irreversibly and severely lost. In Menière's disease, the most common findings on electrocochleography are an increased summating potential to action potential ratio, a widened summating potential/action potential complex, and a disturbed cochlear microphonic potential.4

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Dr G Michael Halmagyi