Which symptom pattern is not typical of Menière disease?

• A. Fluctuating low-frequency hearing loss
• B. Tinnitus during attacks
• C. Aural fullness during attacks
• D. Hearing loss without episodic vertigo or fluctuation

Answer: (D)

The key idea is that Menière disease typically combines episodes of vertigo with fluctuating cochlear symptoms. The classic pattern includes episodic vertigo, fluctuating low-frequency sensorineural hearing loss, and aural fullness with tinnitus that can flare during attacks. Hearing loss that occurs without vertigo episodes and without fluctuation does not fit this pattern, so it’s not typical for Menière. The other symptoms listed—fluctuating low-frequency loss, tinnitus during attacks, and aural fullness during attacks—align with the disease’s fluctuating cochlear disturbance that accompanies vertigo episodes. If hearing loss is static and vertigo is absent, other causes should be considered rather than Menière disease.