It is very important to get a correct Meniere's disease diagnosis,
therefore you need to rule out other possible problems or causes. When you
are finally given a diagnosis of Meniere's disease it means that certain
medical criteria will have been met.
How do the Specialists come up with a Meniere's disease
diagnosis?
There is an established “formula” to which these symptoms and results are
compared. They will either match this formula through all the testing, or
not. In some cases, if hearing is not involved, the Meniere's disease
diagnosis could be Benign Positional Paroxysmal Vertigo (BPPV). Here only
the balance nerve is involved. Again, most of the time, the reason for the
testing is the same: to RULE out any pathology.
All of this testing requires a very detailed history and physical
examination. It also includes visits to different specialists and
facilities, all specializing in different knowledge and technologies. This
is done to collect all the test components to come up with a correct
Meniere's disease diagnosis.
More than likely, you will be sent to one or more specialists: an
otolaryngologist (an ear, nose, and throat specialist commonly referred an
ENT). Depending on your doctor's thoughts, you may be referred to a
neurologist (brain), and often to an audiologist (hearing). The eyes, ears,
and brain are in close proximity. In fact, for a proper Meniere's disease
diagnosis, your entire body is involved. Tests using several technologies
will be ordered.
Overall, this testing process to come up with an accurate diagnosis
requires several visits and time to do the different procedures, await the
results, and then go back for another consultation to have everything
explained.
A Detailed Diagnosis History for Meniere's Disease:
Your general practitioner can do this physical exam and take the history.
In your details, you will need to describe what happens when you have a
Meniere's disease attack. It really helps to have this written down. Better
still, give your doctor a copy of your description of the attack. This helps
your doctor(s) eliminate some conditions fairly quickly and you get a faster
diagnosis so you can work on getting relief from your
Meniere's disease symptoms more
quickly.
They will need a history of the frequency, duration, severity, and
character of your Meniere's disease symptoms and attacks, the duration of
hearing loss and whether it has been changing
for your diagnosis to be as accurate as possible.
Each individual's case must be checked against the possible cause of
middle ear infections (otitis media) or head injury. Other risk factors
include:
- recent viral infections
- respiratory infections
- stress
- fatigue
- use of prescription or nonprescription drugs including aspirin
- a history of allergies, smoking, and alcohol use
In order for the doctor to know if you actually have Meniere's disease,
they have to eliminate some common medical conditions to come up with a
correct diagnosis. You will be asked if you have any history of:
Before you go in to be tested for Meniere's disease, it is a good idea to
be prepared with lots of notes about your thoughts and experiences of your
symptoms and attacks. It is much easier to “recall” medical events when your
doctors are asking you questions if you have already spent some time mulling
them over and writing them down.
A physical examination of the ears and other structures of the head and
neck will be done, but these findings are usually normal, except during a
Meniere's disease episode.
How to diagnose Meniere's disease
Some of the most common tests used for diagnosing Meniere's disease will
include
- MRI
- Audiometric Testing (Hearing) Electronystagmography (ENG)
- Transtympanic electrocochleography (ECOG)
There are other tests available such as an EEG (electroencephalogram) and
others. But these are the basics to rule out any other problems.
Specialists have access to the latest scientific information and testing
and they are able to come up with pretty accurate methods for diagnosing
Meniere's disease. The results you want to hear are that “this is within
normal values” or “everything is normal”. Then you know all is well
physically in your body. Once all the testing is complete and the
specialists' visits are done, you want to visit the “main” consultant to
hear what their impression is.
One thing you may want to keep in mind when you are talking with the
Doctor is that often the terms “Endolymphatic Hydrops” or ‘Hydrops” are used
interchangeably to describe Meniere's disease. Sometimes medical personnel
use other terms. Make sure you ask if something isn't clear.
I want to explain the phrase “electro” that precedes so many of these
medical terms. We are dealing with nerves. Nerves deal with electrical
impulses and how your body automatically responds with them. “Electro”
reflects that electrical impulse. So again, the tests are there to prove
your body is functioning normally.
Some of the most common tests for Meniere's disease
These tests will rule out any other medical conditions that could be
confused for Meniere's disease and they will measure your present level of
hearing and balance.
- Test: Magnetic Resonance Imaging "MRI"
It provides detailed pictures of brain and nerve tissues from multiple
layers without obstruction by any protective bone.
What will this test tell you? MRI is the procedure of choice for most
brain disorders because it can clearly show various types of nerve tissue.
It provides clear pictures. It is noninvasive, meaning it doesn't hurt and
nothing cuts into your body and you are not exposed to any radiation. It is
all done using modern computer technology. It can evaluate blood flow and
the flow of cerebrospinal fluid (CSF). An MRI can show tumors or abnormal
lesions from normal tissues.
How the test is performed The MRI scanner is in a special area that has
been shielded from outside magnetic fields (so as not to interfere with your
results). You lie on a narrow table that can slide inside a large
tunnel-like tube within the tube-like scanner. This scanner creates a
magnetic field around you, and then directs radio waves at the tissues it is
evaluating. Several sets of images are usually required, each taking from 2
to 15 minutes. The complete scan takes about 1 hour; although some scans
take more than 90 minutes. This test will not cause any discomfort, but some
people feel a little shut in. and there is a noise coming from the machine
itself.
An MRI test for Meniere's disease is done to rule out any abnormal
physical conditions in your head. This is a physical image, a picture of the
actual tissue. You might also get a middle ear MRI test for Meniere's
disease.
- Test : Transtympanic electrocochleography (ECOG
Test)
The cochlea is a snail-shaped bony structure in the inner ear and deals
with balance.
What will this test tell you?
The test measures the inner ear pressure, specifically in the cochlea.
The results may indicate increased inner ear fluid pressure. Too much
pressure can affect your balance. Increased fluid pressure puts added weight
and bulk to the natural cochlear activity including surrounding tissue.
“Inner ear pressure” is one of the criteria used in arriving at a correct
diagnosis of Meniere's disease. The test gives specific readings.
How the test is performed
A special tiny sterile electrode tube is placed close to the eardrum to
measure the pressure.
Why is the test done? It is done to check and record the fluid pressure
of the cochlea.
- Test: Electronystagmography "ENG". There also
another test called the Caloric test. It is very similar to the ENG
test, but is done slightly differently.
What will this test tell you?
The ENG test will measure how the acoustic (hearing nerve) and the eye
nerve react to warm and cool water or air applications. (This test does not
include the balance nerve.)
How the test is performed
Small electrodes are gently attached to several positions on the skin
along the outer sides of your eyes. (There are several ways of attaching
these measuring devices.) Once they are in place, warm and cool water (and
sometimes air) are instilled into the ear canal. The recording device notes
all the changes happening with your eyes as this is done. This same process
can also be done “manually” with visual notes. That is the caloric test and
the caloric testing results will be similar to the ENG testing results.
Why is the test done?
It is done to check the “nerve connection” with the eye and hearing
nerves. Both the ENG test and the CALORIC TEST have to do with certain eye
movements. With Meniere's Disease, a certain recognized pattern known as
nystagmus is looked for. It is a quick side by side eye movement that comes
from the water (or air) application.
- Hearing Tests: Audiology is the study of
hearing. All the testing will have specific purposes. Audiometry:
“audio” means sound. So “Audiometry” (measures the sound, ability to
hear.) and Audiogram (plots the sound on a graph) Audiography is another
name for Audiometry.
What will this test tell you?
These tests measure your hearing ability: what sounds and the amount of
sound you hear. There are several different tests: each is done for a very
specific purpose.
An audiometric examination typically indicates a sensory type of hearing
loss in the affected ear. With Meniere's Disease the ability to distinguish
"sit" and "fit" is often impaired in the affected ear. (“Speech
discrimination”)
Part of the basic criteria for a correct Meniere's disease diagnosis is
“hearing fluctuation”. Therefore it is very helpful to have precise
historical documentation.
How the test is performed
You are attached to a variety of machines that collect different
information. Often special “computerized” headphones are used. Some
technology will record what you hear while other information will be
captured on a graph to be printed out. While most of this is done through
the use of headphones, some testing is also done by measuring hearing
conduction BEHIND the ear.
Why is the test done? To create a record of your hearing ability.
- Test: Electroencephalogram (EEG)
What will this test tell you? It helps to diagnose the presence and type
of seizure disorders, head injuries, brain tumors, infections, degenerative
diseases, and metabolic disturbances that all could affect the brain. This
will give you a more accurate diagnosis by identifying some conditions that
may cause Meniere's disease like symptoms.
If you pretend that the brain is the management group of your body, you
will appreciate that it has to be healthy. This shows you its current health
state. The EEG tests the physical and anatomical performance of your brain.
It can't read your mind, nor can it identify any mental (cognitive)
abnormality. Incidentally the procedure cannot be used to "read the mind,"
measure intelligence, or diagnose mental illness. (But with the amazing
scientific advances today, there are tests that can do that.)
How the test is performed
You will have special electrodes applied with glue to your head. It is
not necessary to shave your head in most cases, but you do want to ask if
you need to do anything out of the ordinary in preparation for this test.
Otherwise you will need to lie still as the scanner takes picture of at
different parts of your brain.
Why is the test done? This will provide a graph, (visual) record of your
brain's electrical activity
There are other tests available to support a correct Meniere's disease
diagnosis, but the tests listed above are the most common ones.
IN SUMMARY
Testing for Meniere's disease is a way to rule out any other potential
problem(s). There is no test to say ”you have Meniere's Disease”. There are
normal values or standards for all tests. As each test is completed, a
specialist will then compare your test results to these “normal” values.
These results will then be forwarded to the specialist who ordered the
tests, most likely the ENT. Your own doctor often gets a copy for your
files.
By Karin Henderson - Nurse, Retired.
Google+
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