Date amended:
External
Statements of Principles
Current RMA Instruments:
Reasonable Hypothesis SOP
108 of 2015
Balance of Probabilities SOP
109 of 2015
Changes from Previous Instruments:

Document

ICD coding:

ICD-9-CM:       386.0

ICD-10-AM:    H81.0

Brief description:

This is a progressive disease of the labyrinth of the inner ear with manifestations of rotational spinning (vertigo), fluctuating hearing loss, tinnitus and nausea and vomiting.   

Also known as Meniere’s syndrome, endolymphatic hydrops, labyrinthine hydrops.

Note that Meniere’s disease is bilateral in 10-50% of cases.

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.

The relevant medical specialist is an Ear nose and throat (ENT) surgeon.

Additional diagnoses covered by these SOPs
  • Meniere’s syndrome

  • labyrinthine hydrops

  • endolymphatic hydrops

  • Lermoyez’s syndrome – variant of Meniere’s disease

Conditions not covered by these SOPs   
  • labyrinthinitis#

  • vertigo of central origin#

  • vertigo as a symptom#

  • vestibular Schwannoma* - acoustic neuroma

  • migraine*

  • transient ischaemic attack* - cerebrovascular accident

  • multiple sclerosis* - acoustic neuroma

* 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’s disease.

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 and it is difficult to ascertain whether Meniere’s disease has clinically worsened since the course of Meniere’s disease varies in different individuals. According to Dinces (2015) “some patients have marked hearing fluctuation and progressive hearing loss with infrequent vestibular symptoms; some have severe and frequent vertigo with only mild auditory symptoms; and some manifest both auditory and vestibular symptoms in equal measure” and “approximately two thirds of patients experience vertigo attacks in clusters, while one third have sporadic attacks” and “the frequency of vertigo episodes may decline over time”.

Dinces, E. 2015, ‘Meniere disease’, UpToDate, 9 July, http://www.uptodate.com/contents/meniere-disease

Further comments on diagnosis

Note that though there is an aetiological factor for a severe traumatic brain injury, the SOP itself does not include vertigo of a central origin, so the traumatic brain injury must have caused a disruption of the inner ear’s labyrinth rather than a central brain lesion.