The AAO Criteria for Meniere's Disease

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published a widely used framework in 1995. Under the AAO criteria for Meniere's, a diagnosis of definite Meniere's disease requires all of the following:

• Two or more definitive spontaneous episodes of vertigo, each lasting 20 minutes or longer.
• Audiometrically confirmed sensorineural hearing loss on at least one occasion.
• Tinnitus or aural fullness in the affected ear.
• Other causes excluded by appropriate clinical evaluation.

The AAO criteria for Meniere's also define probable and possible Meniere's disease. Probable disease requires one definitive episode of vertigo with documented hearing loss plus tinnitus or aural fullness. Possible disease is considered when a patient has definitive episodes of vertigo without clear audiometric hearing loss, or a fixed hearing loss with dysequilibrium, and no other identified cause.

The International Criteria

The International Criteria, introduced through the International Classification of Vestibular Disorders and published in 2015, provide a contemporary consensus framework. Under the International Criteria, definite Meniere's disease is diagnosed when all of the following are present:

• Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours.
• Audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear on at least one occasion before, during, or after one episode of vertigo.
• Fluctuating aural symptoms, which may include hearing loss, tinnitus, or aural fullness, in the affected ear.
• The symptoms are not better accounted for by another vestibular diagnosis.

Under the International Criteria, probable Meniere's disease is diagnosed when there are two or more episodes of vertigo or dizziness lasting 20 minutes to 12 hours, fluctuating aural symptoms in the affected ear, and no better alternative vestibular diagnosis, but without audiometric proof of hearing loss.

Comparing the Two Frameworks

Both the AAO criteria for Meniere's and the International Criteria share core features: recurrent episodes of vertigo, hearing loss, and aural symptoms, with exclusion of alternate causes. The International Criteria add an upper limit of 12 hours for vertigo duration and specify a low- to medium-frequency audiometric pattern linked in time to an episode. The AAO criteria for Meniere's do not specify an upper duration limit and require hearing loss documentation on at least one occasion without requiring it to be temporally related to an episode.

The International Criteria are increasingly used in clinical practice and research because they align with a broader international classification of vestibular disorders. The AAO criteria for Meniere's remain important for historical continuity and for comparing older clinical studies. Many clinicians apply elements of both systems when evaluating a patient with suspected Meniere's disease.

Establishing the Diagnosis

Diagnosis of Meniere's disease is based primarily on the clinical history and on audiometric testing. Pure-tone audiometry is used to document hearing thresholds and to identify the characteristic low-frequency pattern. Magnetic resonance imaging of the internal auditory meatus is commonly performed to exclude retrocochlear pathology such as vestibular schwannoma. Vestibular testing may be added in selected cases. Both classification systems emphasise that Meniere's disease is a clinical diagnosis of exclusion, and neither framework replaces the need for careful individual assessment.