A longitudinal study of unilateral Ménière’s disease and
clinical evolutionary models Ménière’s based on the vertigo episodes.
Abstract:
INTRODUCTION: The variability in symptomatic evolution of vertiginous
crisis in Ménière’s disease (MD) is just one more fact that indicates
the great heterogeneity attributed to MD. Recently, these variations and
differences between patients are being defined by different subtypes of
MD.
OBJECTIVES: We have defined subtypes of MD based on the evolution of
vertigo crisis in the first 10 years of the disease, in addition to
defining the natural history of Unilateral MD (UMD) in our environment.
DESIGN: A longitudinal descriptive study of patients with UMD was
carried out. In a subgroup of patients followed from the onset of the
disease, three subtypes or models of UMD were defined according to the
individual review and our experience according to the vertiginous crisis
suffered the first 10 years of the disease. In these models a
differential behavior has been studied attending to different variables
analyzed.
RESULTS: Data were collected from 327 patients with UMD, of which 87
were followed from the onset of the disease. In this subgroup, patients
were grouped in 3 models. Model No. 3 was associated with a worse
auditory prognosis, a greater number of Tumarkin crisis, the need for
surgery, and a more frequent mononymptomatic debut.
Model No. 1 presented a lower hearing loss compared to the rest of the
models.
CONCLUSION: Several studies tried to define subtypes of MD. In our study
we have defined 3 models of behavior in UMD based on the number of
crisis suffered, which present a differential behavior according to
different aspects.
Keywords: “Meniere Disease”, “vestibular diseases”, “longitudinal
studies”, “vestibular disorders”, “inner ear”, “clinical models”,
“Subgroups”, “neurotology”.
Five succinct points:
- In most of uMD patients after the first four years of follow-up, there
is a reduction and stabilization of the average annual number of
vertigo crises
- An exhaustive medical follow-up from the onset of the disease may
reduce the need for a future surgical intervention.
- Unilateral MD patients can be classified according the number of
vertigo crises suffered the first ten years of the disease, on three
clinical evolutionary models.
- Significant differences has been observed when the extent of hearing
loss has been considered in association with the different clinical
models.
- Patients included in model three had a worse disease prognosis in
terms of the number of vertigo episodes, Tumarkin crises and need for
surgical intervention.