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:
  1. 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
  2. An exhaustive medical follow-up from the onset of the disease may reduce the need for a future surgical intervention.
  3. 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.
  4. Significant differences has been observed when the extent of hearing loss has been considered in association with the different clinical models.
  5. 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.