A national survey of the diagnosis and management of Ménière's disease among ENT consultants, UK.

Abstract

Introduction: Ménière's disease (MD) is a rare condition whose diagnosis can be challenging. The American Academy of Otorhinolaryngology-Head and Neck Surgeons (AAO-HNS) has published new guidance to facilitate the diagnosis of MD. We surveyed ear, nose and throat (ENT) consultants in the United Kingdom (UK) to assess their confidence in diagnosing MD, their use of the AAO-HNS guidance and current diagnostic and treatment approaches.

Methods: An online questionnaire was distributed. It asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment for acute attacks and state first- and second-line preventative treatment options.

Results: A total of 86 responses were collected. In total, 88% of respondents reported high levels of confidence in diagnosing MD. Most respondents (29.1%) stated the minimum tests required were 'history', 'otoscopy', 'pure tone audiometry' and 'MRI' (magnetic resonance imaging), although some chose as few as one test (3.49%) and others up to seven (1.2%). Regarding use of the AAO-HNS criteria, responses ranged from 'always' (34.9%) to 'never' (20.9%). Prochlorperazine was the first-line treatment for acute attacks for 81.4% of respondents. Betahistine (38.4%) and dietary restrictions (37.2%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids (34.9%), followed by betahistine (24.4%).

Conclusion: Our survey revealed wide disparities in the diagnosis and management of MD by ENT consultants in the UK, and AAO-HNS guidelines were not universally used. We propose developing greater consensus and intend to conduct a similar international survey to gather a broader perspective.