Which audiometric finding is characteristic of Meniere disease in its early stages?

Explanation

## Audiometric Pattern in Meniere Disease ### Early-Stage Audiometry **Key Point:** Early Meniere disease characteristically shows **low-frequency sensorineural hearing loss** (typically at 500–2000 Hz) with relative sparing of high frequencies — a pattern called **rising audiogram** or **reverse slope** hearing loss. ### Progression Over Time | Stage | Audiometric Pattern | Hearing Loss Type | |-------|---------------------|-------------------| | Early | Low-frequency SNHL | Fluctuating, reversible | | Intermediate | Flattening of audiogram | Mixed frequencies affected | | Late | Flat, severe SNHL | Permanent, all frequencies | ### Mechanism 1. Endolymphatic hydrops causes mechanical distortion of the basilar membrane 2. Low-frequency hair cells (located at the apex of the cochlea) are preferentially affected by pressure changes 3. High-frequency hair cells (base of cochlea) are initially spared 4. As hydrops worsens, the hearing loss becomes **flat** and eventually **high-frequency dominant** **High-Yield:** The **fluctuating nature** of hearing loss in early Meniere disease is pathognomonic. Audiometry may show improvement between episodes, which is not seen in other causes of sensorineural hearing loss. **Clinical Pearl:** Serial audiograms are essential for diagnosis and monitoring. A patient with episodic vertigo + tinnitus + fluctuating low-frequency SNHL has Meniere disease until proven otherwise.