Evaluation of Effects of Treatment Based on Natural Course of Meniere's Disease

Abstract

Some patients with Meniere's disease undergo natural remission of their vertigo, although it is almost always difficult to establish the natural course of Me-niere's disease because of its episodic fluctuating course. In the present study, the natural course of Meniere's disease in the acute stage was examined in six patients. Their subjective and objective symptoms (frequency of spontaneous nystagmus, caloric test and pendular rotation test) were compared with the course of remission in 6 patients treated with steroids. All patients were followed every week for 8 weeks or more. The subjective effect was expressed as the spell index calculated by multiplying duration by number of vertigo attacks in a week in order to amalgamate both intensity and frequency into a single score. Significant decreases (p<0.05) in the spell index and the number of nystagmus were demonstrated during the first two weeks, and then a gradual decrease was noted. Although no difference in caloric excitability was noted between the start and the end of the trial, rotation directional preponderance was significantly (p<0.05) reduced. Subjective improvement of the spell index was significantly (p<0.001) associated with the improvement in the objective results of nystagmic beats. The bound effect of the drug based on natural remission was markedly demonstrated during the first period. Evaluation of the effect of treatment of vertigo should be performed on the basis of natural remission. Further examination is necessary to establish the natural course of Meniere's disease.