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It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low\u2010 to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and\/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and\/or imaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599820909438","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T13:30:17Z","timestamp":1586352617000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":213,"title":["Clinical Practice Guideline: M\u00e9ni\u00e8re\u2019s Disease"],"prefix":"10.1002","volume":"162","author":[{"given":"Gregory J.","family":"Basura","sequence":"first","affiliation":[{"name":"University of Michigan Medical Center Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith E.","family":"Adams","sequence":"additional","affiliation":[{"name":"University of Minnesota Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashkan","family":"Monfared","sequence":"additional","affiliation":[{"name":"George Washington University Washington, DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth R.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Virginia Mason Medical Center Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Antonelli","sequence":"additional","affiliation":[{"name":"University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Burkard","sequence":"additional","affiliation":[{"name":"University of Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Bush","sequence":"additional","affiliation":[{"name":"University of Kentucky Medical Center Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Bykowski","sequence":"additional","affiliation":[{"name":"University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Colandrea","sequence":"additional","affiliation":[{"name":"Duke University School of Nursing and Durham Veterans Affairs Medical Center Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Derebery","sequence":"additional","affiliation":[{"name":"House Ear Clinic Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Boys Town National Research Hospital Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A.","family":"Kerber","sequence":"additional","affiliation":[{"name":"University of Michigan Medical Center Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles F.","family":"Koopman","sequence":"additional","affiliation":[{"name":"C.S. Mott Children\u2019s Hospital Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy Angie","family":"Kuch","sequence":"additional","affiliation":[{"name":"Vestibular Disorders Association Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evie","family":"Marcolini","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Ruckenstein","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla V.","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Vosooney","sequence":"additional","affiliation":[{"name":"Private practice West St Paul Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Consumers United for Evidence\u2010Based Healthcare Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine C.","family":"Nnacheta","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2014Head and Neck Surgery Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nui","family":"Dhepyasuwan","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2014Head and Neck Surgery Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Buchanan","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2014Head and Neck Surgery Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489509121906"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(95)70102-8"},{"issue":"6","key":"e_1_2_11_4_1","first-page":"1462","article-title":"Report of Subcommittee on Equilibrium and Its Measurement. 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