In Meniere disease, which of the following audiometric findings is most characteristic in the early stage?

Explanation

## Audiometric Findings in Meniere Disease ### Early-Stage Hearing Loss Pattern **Key Point:** Early Meniere disease characteristically presents with **low-frequency sensorineural hearing loss** — a rising audiogram (better hearing at higher frequencies, worse at lower frequencies). ### Why Low Frequencies First? The cochlea is affected by endolymphatic hydrops in a specific pattern: - **Cochlear apex** (low-frequency region) is most affected by pressure changes - **Cochlear base** (high-frequency region) is relatively spared early - This produces the distinctive **rising audiogram** (low-frequency dip) ### Progression Over Time | Stage | Audiometric Pattern | Reversibility | |-------|-------------------|---------------| | **Early (first 1–2 years)** | Low-frequency SNHL, rising curve | Often reversible between attacks | | **Intermediate (2–5 years)** | Flat or mixed low- and mid-frequency loss | Partially reversible | | **Late (>5 years)** | Descending high-frequency loss (like presbycusis) | Permanent | **High-Yield:** The **rising audiogram** is pathognomonic for early Meniere disease and helps distinguish it from other causes of SNHL (presbycusis, noise-induced hearing loss, and ototoxicity all show descending patterns). **Clinical Pearl:** Hearing loss may **fluctuate** between episodes in early disease — this fluctuation is a diagnostic clue. Once the disease progresses to the late stage, hearing loss becomes fixed and may resemble presbycusis. ### Mnemonic: **EARLY MENIERE = LOW-FREQ LOSS** - **E**arly disease → **L**ow-frequency affected - **L**ate disease → **L**ate-frequency (high-frequency) affected