An International Survey of the Diagnosis and Management of Ménière's Disease Amongst Otolaryngology Consultants.

Ménière's Disease (MD) is a disease that may be difficult to diagnose and manage. Our UK survey showed variability in the practice of UK Otolaryngology consultants. We hence surveyed Otolaryngology consultants internationally, to assess their confidence levels in diagnosing MD, their use of the AAO-HNS guidelines and current diagnostic and treatment modalities. An online questionnaire was distributed internationally over four weeks. The questionnaire asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment modalities for acute attacks, and state their 1st and 2nd-line preventative treatment options. A total of 173 responses were collected with 77% of respondents reporting high levels of confidence in diagnosing MD. Most respondents stated the minimum tests required were "History, Otoscopy, Clinical Vestibular testing, and Pure Tone Audiometry" although some chose as few as 1 test. Regarding the use of the AAO-HNS criteria, responses ranged from "always" (20.2%) to "never" (22.5%). Cinnarizine was the first-line treatment for acute attacks followed by betahistine. Betahistine (30.1%) and dietary restrictions (28.3%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids injection (30.1%). Our survey revealed disparities in the diagnosis of MD and its management, like the results of our previously conducted UK survey. This suggests the need for an international consensus regarding the diagnosis and subsequent management strategies for this disease.