## Hearing Loss Pattern in Meniere Disease ### Early-Stage Characteristics **Key Point:** Early Meniere disease presents with **fluctuating low-frequency sensorineural hearing loss**, which is reversible and improves between attacks. ### Audiometric Features | Feature | Early Meniere | Late Meniere | |---------|---------------|---------------| | **Frequency affected** | Low (125–1000 Hz) | All frequencies | | **Pattern** | Fluctuating | Progressive, permanent | | **Reversibility** | Yes (between attacks) | No (becomes fixed) | | **Type** | Sensorineural | Sensorineural | | **Mechanism** | Functional (ion imbalance) | Structural (hair cell loss) | ### Pathophysiological Basis 1. **During attack:** Endolymphatic pressure increases → Reissner membrane ruptures → ion mixing → hair cell dysfunction (reversible) 2. **Between attacks:** Membrane reseals → hearing recovers 3. **After repeated attacks:** Cumulative hair cell damage → permanent hearing loss (all frequencies) **High-Yield:** The **reversibility of hearing loss between attacks** is a diagnostic clue that distinguishes early Meniere disease from other causes of sensorineural hearing loss. **Mnemonic:** **LOFAR** — **LO**w-**F**requency, **A**udiometry, **R**eversible (early Meniere) **Clinical Pearl:** Serial audiometry showing fluctuating thresholds, especially at low frequencies, is highly suggestive of Meniere disease and supports the diagnosis when combined with episodic vertigo and tinnitus. 
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