メニエール病の長期観察：保存的治療症例を中心に

Abstract

This study was designed to investigate retrospectively the long-term prognosis of vertigo and hearing impairment in Meniere's disease. The results of mostly conservative treatments against vertigo and hearing impairment were evaluated in 39 patients with typical Meniere's disease on the basis of AAO-HNS's 1995 Guideline.The total number of vertigo attacks and the worst mean value of 4 frequency hearing levels were examined for 6 months after four periods, which were the first visit to our hospital, and 2 yrs, 10 yrs and 20 yrs later.The mean values from the worst mean of 4 frequency hearing levels for 6 months since the first visit day, and 2 yrs, 10 yrs and 20 yrs later, were 43 dB, 46 dB, 55 dB and 76 dB, respectively. Stage classification for 6 months since the first visit showed that stage 1 (less than 25 dB), stage 2 (26-40 dB), stage 3 (41-70 dB) and stage 4 (more than 71 dB) were 24%, 16%, 50% and 10%, respectively. In the time course of 2 yrs the rate of stage 1 decreased to 16%. The rate of the stage 4 increased from 10% to 27% 10 yrs later and to 67% 20 yrs later.The mean worst hearing levels showed 14% improved (improved more than 10 dB) and 35% worsened (worsened more than 10 dB) hearing at 2 yrs later. The rate of improved hearing decreased to 9% and that of worsened hearing increased to 50% 10 yrs later. Comparison of the rate of vertigo attacks for 6 months between the first visit and 2 yrs later revealed 63% at class A (completely controlled) and 83% at class A plus B (improved). At 10 yrs later, 60% was class A and 80% class A plus B. Vertigo attack completely disappeared in all four stages 20 yrs later It was considered important for the prevention of progressive non-recovery hearing loss to provide adequate therapy for Meniere's disease within 2 yrs after the patient's first visit.