OBJECTIVES: To evaluate the onset of vertigo, hearing loss and tinnitus in 
Ménière's disease and the associated endolymphatic hydrops (EH) of the inner 
ear.
DESIGN: Multicentre evaluation of three patient groups.
SETTINGS: Disease-specific symptoms were reviewed among referred patients in a 
tertiary referral hospital in Finland and in members of a Finnish Ménière 
Association in Finland. The MRI of a separate group of patients was undertaken 
in a tertiary referral centre in Japan.
PARTICIPANTS: 340 patients were reviewed in the referral hospital along with 740 
members of the Ménière Association. MRI was undertaken in 224 patients in Japan.
PRIMARY AND SECONDARY OUTCOME MEASURES: Latency and symptom development in 
Ménière's disease, and the appearance of EH of the inner ear in monosymptomatic 
patients and in Ménière's disease.
RESULTS: The mean age of the first symptom was 43.8 years, with 10% of the 
patients being older than 65 years. The time delay between hearing loss and 
vertigo was more than 5 years in 20% of the members and of the patients. 
Gadolinium-contrasted MRI demonstrated EH in 90% of the patients with Ménière's 
disease, in which 75% was bilateral among patients with unilateral symptoms. In 
monosymptomatic patients with vertigo, tinnitus or hearing loss; EH was 
demonstrated in 55-90% of the patients either in the cochlea and/or the 
vestibulum of the symptomatic ear.
CONCLUSIONS: Ménière's disease often shows bilateral EH and comprises a 
continuum from a monosymptomatic disease to the typical symptom complex of the 
disease. We suggest that a 3T MRI measurement should be carried out in patients 
with sensory-neural hearing loss, vertigo and tinnitus, 4 h after the 
intravenous injection of a gadolinium-contrast agent to verify the inner ear 
pathology. This may lead to a better management of the condition.