The Degree of Audiovestibular Loss Is Not Related to Current Vertigo Attacks in Refractory Unilateral Ménière's Disease.

Abstract

Background: Unilateral Ménière's disease (MD) is characterized by severe episodic attacks of rotational vertigo and audiovestibular signs that include fluctuating sensorineural hearing loss, aural fullness, tinnitus, and vestibular loss.

Purpose: To investigate the relationship between the degree of audiovestibular loss, symptoms, and the number of vertigo attacks during the previous 6 months and 1 month of patients with MD.

Study sample: Sixty patients with active MD refractory to oral treatment.

Data collection and analysis: Hearing (pure-tone audiometry and speech discrimination) and vestibular (caloric test, vestibular evoked myogenic potential [VEMP]) tests were performed. Symptoms were scored using the following validated questionnaires: Vertigo Symptom Scale-short form, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Aural Fullness Scale, and Functional Level Scale. Linear regression, a factor analysis, and a correlation analysis were conducted.

Results: Patients experienced a mean number of 16 attacks (range, 2-65) during the previous 6 months and five attacks (range, 0-30) during the previous 1 month. Hearing and vestibular functions were reduced in the affected ear. Linear regression, the factor analysis, and the correlation analysis showed no association between the degree of audiovestibular loss and the number of vertigo attacks during the previous 6 months or 1 month or symptoms of disease activity. An exploratory analysis showed evidence of some associations between the degree of hearing loss, caloric paresis, and VEMP asymmetry, indicating a consistent pattern of loss across the cochlear semi-circular canals and saccules.

Conclusion: Although audiovestibular tests help establish diagnoses, they cannot determine current disease activity of unilateral refractory MD.

Clinical relevance statement: It may be prudent to assume that patients with MD and high remaining vestibular function in the affected ear would experience more frequent episodes of vertigo and intense dizziness and experience more troublesome symptoms. Conversely, it may be prudent to assume that patients with MD with low remaining vestibular function in the affected ear would experience fewer episodes of vertigo; however, as shown by these results, this does not seem to be the case. No obvious audiovestibular markers suggest that intratympanic therapy for vertigo treatment should be delayed.