Distinguish the typical presentations of Menière disease versus vestibular schwannoma.

• A. Both conditions typically present with progressive bilateral SNHL.
• B. Menière disease has constant vertigo and stable hearing, while schwannoma has fluctuating hearing.
• C. Menière: episodic vertigo with fluctuating low-frequency SNHL and tinnitus; vestibular schwannoma: progressive unilateral SNHL with vestibular symptoms.
• D. Schwannoma presents with hearing loss but no vestibular symptoms.

Answer: (C)

A clear way to distinguish these conditions is by how they affect hearing and balance over time. Menière disease typically presents with episodes of vertigo that come and go, paired with fluctuating low-frequency sensorineural hearing loss and tinnitus. The hearing loss isn’t steady; it waxes and wanes with each attack, especially affecting the low frequencies early on.

Vestibular schwannoma, on the other hand, usually shows a progressive, unilateral sensorineural hearing loss that worsens over time, along with vestibular symptoms such as imbalance or vertigo related to the tumor’s impact on the vestibular nerve. The hearing loss tends to be gradual and persistent rather than fluctuating.

So the best summary is: Menière disease features episodic vertigo with fluctuating low-frequency hearing loss and tinnitus, while vestibular schwannoma features progressive unilateral hearing loss with accompanying vestibular symptoms.