Task force of the Brazilian Society of Otology and the Brazilian Academy of Neurotology: Menière’s Disease

Abstract

Objective To critically review the available evidence on the pathophysiology and diagnosis of Menière’s disease and to provide consensus-based recommendations developed by a task force of the Brazilian Society of Otology and the Brazilian Academy of Neurotology. Methods A task force consisting of experts in otology and neurotology was established to review the scientific literature and develop thematic sections of the document. The content was discussed in both in-person and remote meetings until consensus was achieved. Recommendations were graded according to level of evidence and strength of recommendation using standardized systems for the evaluation of therapeutic interventions and diagnostic methods. Results Menière’s disease is a heterogeneous clinical condition characterized by recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic hydrops represents the most consistent histopathologic finding; however, it does not alone explain the clinical expression of the disease. Current evidence indicates the involvement of multifactorial mechanisms, including genetic predisposition, immune dysfunction, inflammatory processes, and changes in inner ear ion homeostasis. Diagnosis remains primarily clinical, based on international criteria, with serial audiometry playing a key role. Electrophysiologic testing and imaging may be useful in selected situations. Clinical variability supports the concept of subphenotypes with potential diagnostic and prognostic implications. Conclusion Menière’s disease should be recognized as a heterogeneous and multifactorial clinical entity. Diagnosis requires careful clinical evaluation and longitudinal follow-up. Advances in the understanding of pathophysiologic mechanisms and the identification of subphenotypes may contribute to more individualized diagnostic and therapeutic strategies.