Limitations and strengths
The present study suffers from biases typical of an observational study, although these would be non-differential biases whereby all patients would be equally affected, regardless of the subgroup they belong to. As such, the estimated associations would tend towards a null value (no association). Furthermore, we have not taken into account variables such as the association with autoimmune diseases or any family history of the disease, which are now considered as variables defining possible subtypes of MD.
Conversely, we provide data from a longitudinal study carried out on a large number of patients with a long follow-up. Moreover, we have performed an analysis of variables related to MD and their outcomes in different subgroups. To date, no study has yet attempted to explain the existence of different evolutionary models of the disease in this sense and hence, we believe that our study may offer a new perspective to define the existence of different subtypes of uMD.
5.CONCLUSIONS
In most of the uMD patients, after the first four years of disease follow-up, there is a reduction and a stabilization in the mean number of annual episodes of vertigo. An in depth analysis of the number of episodes of vertigo over the first 10 years of disease evolution has enabled us to define 3 clinical models based on the evolution of the episodes of vertigo suffered in the first 10 years of the disease. Patients included in model number one showed significantly less hearing loss at the end of follow-up. The patients included in model three had a worse disease prognosis in terms of the number of vertigo episodes, number of Tumarkin crises, a greater need for surgical intervention and a mono-symptomatic onset.
The data presented here offer criteria that may help to predict the evolution of MD in different subsets of patients, enabling their treatment to be better personalized, while encouraging a close follow up of the episodes of vertigo in UMD patients.
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9. FIGURE CAPTIONS
Fig 1. Average incidence according to year of follow-up of the disease in UMD patients.
Fig 2. Average incidence according to five-year follow-up of the disease in UMD patients.
Fig 3. Course of disease for each subtype expressed in the mean annual number of vertigo episodes suffered in the first ten years.