## Hearing Loss Pattern in Meniere Disease ### Early-Stage Audiometric Features **Key Point:** In early Meniere disease, hearing loss is **fluctuating** and **sensorineural**, with a characteristic **low-frequency predominance** (reverse of typical age-related hearing loss). ### Why Low Frequencies? The endolymphatic hydrops preferentially affects the apex (cochlear base) of the cochlea, which encodes low frequencies. The stapes footplate region is compressed by the bulging membranous labyrinth, causing: - Hearing loss at 250–1000 Hz - Relative preservation of high frequencies (4000–8000 Hz) early on This creates a **rising audiogram** (low-frequency dip) — the opposite of presbycusis. ### Fluctuation Over Time | Stage | Hearing Pattern | Mechanism | |-------|-----------------|----------| | **Early (months to years)** | Fluctuating, low-frequency SNHL | Reversible endolymph pressure changes | | **Late (years to decades)** | Flat or high-frequency SNHL | Permanent cochlear damage, organ of Corti atrophy | **High-Yield:** The **fluctuating nature** is pathognomonic — hearing may improve between attacks and worsen during them. This distinguishes Meniere from sudden sensorineural hearing loss (SSHL), which is sudden and non-fluctuating. **Clinical Pearl:** Patients often report that hearing improves after an acute vertigo attack subsides, reflecting resolution of the acute endolymphatic pressure spike. **Mnemonic:** **FLAN** — **F**luctuating, **L**ow-frequency, **A**ffects early, **N**on-progressive initially (in some patients). [cite:Robbins 10e Ch 29; Harrison 21e Ch 428] 
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