A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests

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.

Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo

“…A detailed scrutiny of symptoms has shown the existence of different subtypes or clinical variants in the unilateral (4) and bilateral (5) presentations of definite MD. This has also occurred in the case of bedside vestibular examination (6), auditory (7), and vestibular testing (8,9). MRI detection of EH is the result of high tech combined with complex sequence parametrization to allow the identification of the minute sensory and supporting structures of the inner ear within very hard dense bone.…”

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease

“…41 Alterations in cVEMP parameters, which vary from study to study, have also been reported in MD cases. Absent cVEMP was mentioned in SE and AE, 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 44 , 45 , 46 prolonged P1 and/or N1 latencies, 24 , 31 , 32 , 34 , 36 , 44 , 46 decreased inter-amplitude, 24 , 44 and altered asymmetry index. 33 , 35 , 47 …”

“…32 Altered oVEMP parameters have also been mentioned in MD, with variable results in the literature. Absent VEMP was mentioned in SE and AE, 30 , 33 , 34 , 35 , 36 as well as alterations in P1 and/or N1 latencies 32 , 34 , 36 , 46 and asymmetry index. 33 , 35 , 47 …”

“…Hearing loss occurred in decreasing order of prevalence in stages 3; 2; 1 and 4, characterizing a predominance of moderate to severe auditory disorders, similar to findings reported in MD. 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 …”

“…MD duration was highly variable, ranging from a few months to two decades, with an average of less than six years, comparable to the literature, although longer duration has also been reported. 24 , 31 , 32 , 35 , 36 …”