A 52-year-old woman presents with recurrent episodes of severe vertigo lasting 20 minutes to 3 hours, accompanied by tinnitus, aural fullness, and fluctuating sensorineural hearing loss. Audiometry shows low-frequency hearing loss. Which of the following is NOT a characteristic feature of Meniere disease?

Explanation

## Characteristic Features of Meniere Disease **Key Point:** Meniere disease is characterized by endolymphatic hydrops causing the classic tetrad of vertigo, tinnitus, aural fullness, and fluctuating sensorineural hearing loss—NOT conductive hearing loss. ### Pathophysiology Meniere disease results from increased endolymph volume (endolymphatic hydrops) within the membranous labyrinth. This causes: - Rupture of Reissner membrane → mixing of endolymph and perilymph - Potassium toxicity to vestibular and cochlear hair cells - Acute vertigo and hearing fluctuation ### Audiological Findings | Feature | Meniere Disease | Conductive Loss | |---------|-----------------|------------------| | **Type** | Sensorineural | Conductive | | **Frequency affected** | Low frequencies (early) | All frequencies equally | | **Air-bone gap** | Absent | Present (>20 dB) | | **Weber test** | Lateralizes to normal ear | Lateralizes to affected ear | | **Rinne test** | BC > AC bilaterally | BC > AC on affected side | **High-Yield:** Conductive hearing loss with air-bone gap is NOT seen in Meniere disease. The hearing loss is always sensorineural (bone conduction better than air conduction on affected side, but no air-bone gap). ### Vestibular Signs During Acute Attack **Clinical Pearl:** The nystagmus in Meniere disease during an acute attack is typically: - **Horizontal-rotatory** nystagmus - **Slow phase toward the affected ear** (indicating peripheral vestibular lesion) - **Positive Romberg test** — patient sways toward affected side due to vestibular imbalance - **Positive Fukuda stepping test** — patient rotates toward affected side ### Histopathological Hallmark **Endolymphatic hydrops** is the pathological hallmark — confirmed only by temporal bone histology (rarely done in living patients). This is the structural basis of all symptoms. ### Why Conductive Loss Is Wrong Conductive hearing loss implies a middle ear problem (ossicular chain disruption, TM perforation, stapes fixation). Meniere disease affects the inner ear (cochlea and vestibule), producing **sensorineural** loss with normal middle ear function and no air-bone gap.