Meniere Disease and Meniere syndrome F013

Current RMA Instruments:

Changes from Previous Instruments:

ICD coding:

ICD-10-AM: H81.0

Brief description:

Meniere disease is uncommon and occurs without a known cause (idiopathic). It is usually not life-threatening but can be chronic and quite disabling. This condition affects the inner ear and leads to recurring episodes involving vertigo (severe dizziness/spinning sensations), fluctuating sensorineural hearing loss, tinnitus and sometimes nausea and vomiting. Meniere’s disease is bilateral in 10-50% of cases.

Meniere syndrome is when the same symptoms or manifestations are present but the condition is due to a known underlying cause and secondary to another medical condition or injury. 

Confirming the diagnosis:

To confirm the diagnosis there needs to be an opinion from an Ear nose and throat (ENT) surgeon. Normal practice is to consider that Meniere’s disease is present when there is episodic vertigo in addition to sensorineural hearing loss and tinnitus or fullness in the ears.

Diagnosis is often best confirmed by Ear, nose and throat (ENT) surgeons .

Additional diagnoses covered by these SOPs

• Labyrinthine hydrops
• Primary endolymphatic hydrops
• Secondary endolymphatic hydrops
• Lermoyez’s syndrome – variant of Meniere’s disease

Conditions not covered by these SOPs   

• Labyrinthinitis/vestibular neuritis #
• Vertigo of central origin #
• Vertigo as a symptom #
• Vestibular Schwannoma* - acoustic neuroma
• Vestibular migraine*

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

The assessment of the clinical onset begins with the confirmed diagnosis, then goes back in time to the first onset of reliable clinical symptoms and signs which are pathognomonic of Meniere disease or Meniere syndrome.

Clinical worsening

For an aggravation to be relevant, there must be a clinical worsening out of keeping with the natural history of the underlying pathology. It is difficult to ascertain whether Meniere disease has clinically worsened because the course of Meniere disease varies in different individuals. It is recommended that when considering any possible clinical worsening, the advice of an ENT surgeon is sought. 

Further comments

Although there is a factor related to moderate to severe traumatic brain injury, the traumatic brain injury needs to cause a disruption of the inner ear’s labyrinth for this factor to be considered relevant (rather than the problems being related to a central brain injury with no involvement of labyrinth).