Meniere’s Disease (A Clinicoaudiological Prospective Study)

Abstract

Background: Meniere’s disease (MD) is a disease of the inner ear that causes vertigo, fluctuating hearing loss, tinnitus and aural fullness. The etiology is multifactorial. A characteristic sign of MD is endolymphatic hydrops, in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. The diagnosis of MD is based on clinical symptoms and complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually consideredObjectives: To throw some light on Meniere’s disease in Basra and to determine the diagnostic value of cVEMP and PTA in patients with Meniere’s disease and their relation to the clinical features. Patients and method: It is a clinical, descriptive, prospective cross sectional study carried out from October 2019 to February 2021 at Basra otolaryngology center in Basra teaching hospital. The study included 70 patients diagnosed with unilateral Definite MD according to the clinical criteria proposed by Barany society and International classification of Vestibular Disorder (ICVD) 2015, of whom 36 were females and 34 were male, female to male ratio 1.05:1, aged between 16 years and 63 years with a mean of 43 years. A full Clinical history, General physical examination, otoneurological examinations, and audiological tests including pure tone audiometry and cVEMP was done. Data was collected and included in a data based system and analyzed by (SPSS v.23). Data were presented using descriptive statistics which expressed as frequencies and percentages, P-value less than 0.05 considered significant. Results: The majority of the affected patient within the age group of 41-50 years (36%) while 4% in 11-20 years, 11% in 21-30 years, 22% in 31-40 years, 20% in 51-60 years, and 7% of more than 60 years. With no significant sex predisposition. Regarding the affected side, right side involved in 51% of cases, while left side involved in 49% of them.  Regarding the duration of the disease it’s found that 36% of the studied patients had less than 1year, while 37% of them had (1-5 years duration) and 27% of them had more than 5 years duration. Positive family history of same illness in first and second degree relatives is present in 71% of patients. All of the patients having a low frequency SNHL of variable severity, its mild in 24.3%, moderate in 48.6%, sever in 21.4%, and profound in 5.7% of cases. cVEMP amplitude ratio is abnormal in 87% of patients(61 patients), and this indicate that the cVEMP have a good diagnostic value in patient with MD. There is no significant relation between the result of cVEMP and the severity of low frequency SNHL (P value 0.5). Also there is no significant relation between the severity of low frequency SNHL and the duration of the disease (P value 0.08).Conclusion: Meniere’s disease affect different age group but the age group (40-50 years) being more predominant. With No significant sex predilection. Its diagnosis is mainly clinical and augmented by using simple, readily available clinical tests of hearing and vestibular function (PTA , cVEMP). cVEMP have a good diagnostic value in patients with unilateral definite Meniere’s disease.