A task force of the Brazilian Society of Otology and the Brazilian Academy of Neurotology reviewed the evidence on the mechanisms and diagnosis of Ménière's disease and reached graded consensus recommendations.
The group describes the disease as heterogeneous: endolymphatic hydrops is the most consistent pathological finding but does not explain the clinical picture on its own, and genetic, immune, inflammatory and ion-transport mechanisms all appear to contribute. Diagnosis remains clinical, using international criteria, with serial audiometry playing a central role. Electrophysiological tests and imaging are reserved for selected cases. Recognising subphenotypes may in future guide prognosis and treatment.
For most clinicians this reinforces what to do rather than changing it: take a careful history of attacks, document fluctuating low-frequency hearing loss with repeated audiograms, and avoid labelling every episodic vertigo as Ménière's.
The document is consensus-based, and its treatment recommendations should be read in the full text.
- Diagnose Ménière's disease clinically using international criteria.
- Repeat audiometry to document fluctuating hearing loss.
- Reserve electrophysiology and imaging for uncertain or atypical cases.
- Consider vestibular migraine and other mimics before settling on the diagnosis.
Why it matters
Ménière's is over-diagnosed in episodic vertigo, and serial audiometry is the inexpensive test that anchors it.
Don't overread it
A consensus review, not new trial evidence; it does not change established diagnostic criteria.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free