Ménière's Disease: A Tri-Decade Scoping Review of Treatment Trends and Evidence Quality.

INTRODUCTION: Ménière's disease (MD) is a complex inner ear disorder defined by endolymphatic hydrops and a triad of episodic vertigo, fluctuating hearing loss, and tinnitus. Despite AAO-HNS diagnostic guidelines, disease heterogeneity and lack of treatment consensus persist. OBJECTIVE: This study conducts a tri-decade scoping review (1994-2024) to evaluate the MD evidence base, shifts in management, and methodological rigor regarding AAO-HNS and CONSORT compliance. MATERIALS AND METHODS: A systematic search of PubMed, CINAHL, and Cochrane (2014-2024) identified English-language RCTs and prospective cohorts involving adults. Studies were graded via the Oxford CEBM system, with guideline compliance analyzed using IBM SPSS v29.0. A scoping review framework was adopted to map the "Quality Paradox" between evidence hierarchy and reporting standards. RESULTS: From 1344 publications, 257 studies met inclusion criteria. While research volume surged-with Level 2 studies quadrupling (p < 0.01) and Level 3 studies tripling (p < 0.05)-reporting standards significantly declined. Adherence to AAO-HNS diagnostic and treatment-outcome criteria dropped to 73% and 34%, respectively. Clinically, management shifted toward preservation-focused interventions, including hydrops-visualizing MRI, intratympanic steroids over gentamicin, and increased cochlear implantation, alongside a decline in positive-pressure device use. CONCLUSION: The MD evidence base increasingly favors non-ablative, patient-centered interventions. However, the validity of these advancements is threatened by a significant decline in reporting compliance. To safeguard the evidence base, journals must enforce standardized reporting as a nonnegotiable prerequisite for publication. LEVEL OF EVIDENCE: N/A.