Abstract
To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in “grading” the severity of MD.
Highlights
Menière’s disease (MD), named after Prosper Menière, is an inner ear disorder characterized by spontaneous episodes of vertigo attacks [1], which is often accompanied by fluctuating sensorineural hearing loss (SNHL), tinnitus, and aural fullness [2,3,4]
The overall null result strongly suggests that pure-tone average (PTA)-based MD stages are poorly associated with vertigo severity and vestibular functions
We found that neither the clinical symptoms nor the abnormal rates of each individual vestibular test were significantly different across the four MD stages (Table 1) that were defined by the degree of HL
Summary
Menière’s disease (MD), named after Prosper Menière, is an inner ear disorder characterized by spontaneous episodes of vertigo attacks [1], which is often accompanied by fluctuating sensorineural hearing loss (SNHL), tinnitus, and aural fullness [2,3,4]. The prevalence of MD has been estimated to be 0.27% in the United Kingdom on the basis of cross-sectional data over 500,000 participants in the UK Biobank collected between 2006 and 2010 [5]. A study in the United States reported an estimated prevalence of 0.19% on the basis of information obtained from a health claims database between 2005 and 2007, which included 60 million records [6]. MD is a complex, heterogeneous disorder in which numerous underlying factors interact, including anatomical variations in the temporal bone, autoimmunity, and altered intralabyrinthine fluid dynamics due to abnormal functions of ion channels and transporters [1, 7,8,9]. The exact etiology of EH and its role in MD are still poorly understood [8, 9, 17]
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