Clinical hints and precipitating factors in patients suffering from Meniere's disease.

Meniere disease is one of the most fascinating and most vexing of all clinical conditions encountered by the otolaryngologist. Operationally speaking, a Meniere ear is a fragile ear. In fact, Meniere disease can and should be redefined as a degenerating inner ear that has impairment of one or more homeostatic systems, resulting in instability of hearing and balance function. This updated definition is a valuable guide to the clinical epidemiology and presentation of Meniere disease and to understanding the effects of conservative treatments. In the absence of a definitive test for Meniere disease, the greatest challenge for the clinician may be differentiating this condition from migraine. Ultimately, Meniere vertigo attacks are controllable in more than 99% of cases, but hearing loss and other auditory symptoms tend to be unresponsive to treatment.