Preliminary guidelines for reporting treatment results in Menière's disease conducted by the Committee of the Japanese Society for Equilibrium Research, 1993

Improvement of vertigo symptoms and acoustic power absorbance in cases with endolymphatic hydrops

Objective

The pathophysiology and symptoms underlying Meniere's disease (MD) manifest as endolymphatic hydrops (EH), potentially impacting acoustic power absorbance in vestibular EH. The longitudinal effects of middle ear pressure therapy (MEPT) and conservative therapies for EH by magnetic resonance imaging (MRI) and on acoustic power absorbance on wideband acoustic immittance (WAI) were evaluated, and their changes were compared with clinical symptoms.

Methods

Eleven patients with definite MD or delayed endolymphatic hydrops (DEH), resistant to conservative therapies and who continued MEPT for 1 year, were included. Vertigo scores, hearing levels, acoustic power absorbance on WAI, and degrees of EH on 3-T MRI were evaluated and compared before and after the treatments.

Results

One year after the start of MEPT, all cases showed symptomatic improvement in vertigo score; however, the degrees of EH showed no improvements except in one case. In the affected ears with EH, their absorbances on WAI improved, particularly at 1580-1905 or 2400-2953 Hz (p < .05).

Conclusion

Alleviation of vestibular symptoms with the therapy of MD was not necessarily associated with improved EH. Vestibular symptoms could be related to the change in the impedance of inner ear pressure, which was proven by the normalization of acoustic power absorbance. Assessments of acoustic power absorbance may provide useful information for physiological conditions and causative factors of vertigo in ears with EH.

Level of evidence

4.

12-month effect of middle ear pressure therapy with the EFET01 device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan

BACKGROUND

Middle ear pressure therapy (MEPT) is effective for intractable vertigo in patients with definite Meniere's disease (MD) and treatment-refractory delayed endolymphatic hydrops (DEH). Four-month MEPT with the EFET01^®, an MEPT device developed in Japan and covered by national health insurance since September 2018, has shown efficacy. However, efficacy and safety after 12 months of treatment, which is appropriate for determining the therapeutic effect of MEPT devices, is unclear.

OBJECTIVES

Examine the therapeutic effect of 12-month MEPT using the ETET01^®.

MATERIAL AND METHODS

Patients underwent MEPT using the EFET01^® from September 2018 to July 2021. Thirty-three patients followed for >12 months were enrolled in this retrospective study. Clinical data were evaluated in the first and second 6-month treatment periods. Data from the second 6-month period were compared with data from an MEPT study using a different device.

RESULTS

MEPT with the EFET01^® significantly improved vertigo in the first period, with further improvement in the second period. The efficacy and safety were comparable to MEPT with other devices.

CONCLUSIONS

MEPT with the EFET01^® is effective for intractable vertigo in patients with definite MD and DEH, and 12-month follow-up is recommended.

SIGNIFICANCE

The efficacy of 12-month MEPT with the EFET01^® was demonstrated.

Efficiency of a novel middle ear pressure device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan

BACKGROUND

Middle ear pressure therapy (MEPT) is effective in treating intractable vertigo in patients with definite Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) refractory to conservative treatment. A novel middle ear pressure device, the EFET01^®, which requires no transtympanic ventilation tubes, was developed in Japan, approved by the Japanese Ministry of Health, Labour and Welfare, and has been used under Japanese national health insurance since September 2018.

OBJECTIVES

To examine short-term therapeutic effect of MEPT using the ETET01^® compared with previous clinical trial results.

METHODS

Patients selected according to Japan Society for Equilibrium Research (JSER) guidelines underwent MEPT using the EFET01 from September 2018 to July 2021, and 44 patients were enrolled in this retrospective study. Clinical data analysed at 4 months after the start of MEPT were compared with those of the previous clinical trial for the EFET01.

RESULTS

MEPT using the EFET01 showed the same therapeutic efficacy as that of the previous clinical trial, i.e. improvement in the intensity and frequency of vertigo with no effect on hearing, even under JSER guidelines for proper use of MEPT.

CONCLUSION

MEPT using the EFET01 provided an effective treatment option for intractable vertigo in patients with definite MD and DEH.

Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops

BACKGROUND

A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device.

OBJECTIVES

The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months.

MATERIALS AND METHODS

Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device.

RESULTS

In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study

BACKGROUND

The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device.

OBJECTIVES

The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device.

MATERIALS AND METHODS

23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device.

RESULTS

In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report

CONCLUSION

Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH).

OBJECTIVE

The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device.

METHODS

Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device.

RESULTS

With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.

Distortion product otoacoustic emissions after intratympanic gentamicin therapy for unilateral Ménière's disease

The treatment of patients with Ménière's disease that do not respond to conventional therapy becomes complicated, particularly when taking into account the issue of hearing damage as well as the control of vertigo. Treatment often involves the intratympanic administration of gentamicin, for which different protocols are used. Hence, it is important that we better understand how this treatment influences hearing, beyond mere audiometric assessments. The aim of this prospective study was to evaluate the effect of intratympanic gentamicin treatment for Ménière's disease on cochlear function, as assessed by otoacoustic emissions. The 41 patients included in the study had been diagnosed with unilateral Ménière's disease as defined by the American Academy of Otolaryngology-Head and Neck Surgery guidelines (1995), and had been refractory to medical treatment for at least 1 year. Intratympanic injections of gentamicin at a concentration of 27 mg/ml were performed at weekly intervals until indications of vestibular hypofunction appeared in the treated ear. Before beginning the treatment and 3 months after ending it, pure tone and speech audiometry tests were performed and the results are expressed in terms of the pure tone average (0.5, 1, 2, and 3 kHz) and the speech discrimination score, respectively. At the same time, a distortion product otoacoustic emission (DPOAE) study was performed and the results are expressed in terms of its presence or absence, and as the amplitude and threshold of the emission. When analyzed 3 months after the treatment had terminated, hearing loss was seen in 13 patients (31.7%). However, no significant change in the threshold and/or amplitude of otoacoustic emissions was observed in any of the patients. Neither were changes in the audiometric stage, number of injections required or the existence of DPOAE before treatment detected. Hence, the treatment method used here for patients with intractable unilateral Ménière's disease can be considered as having a low risk on auditory function, as assessed both audiometrically and with otoacoustic emissions, and can be considered as subablative for hearing function.

[Normative study and reliability of French version of the dizziness handicap inventory]

GOAL

To determine the normality per age group of the "Echelle du Handicap lié aux Troubles de l'Equilibre et aux Vertiges" (EHTEV) French version of the "Dizziness Handicap Inventory" (DHI) and to assess the effect of sex on the scores and the reproductibility.

SUBJECTS AND METHODS

The normative scores and the effect of the sex were determined in a group of 120 subjects without any instability disorder. Sixty-three women and 57 men, aged 20-79 years were graded by age section of 10 years. After 8-10 weeks the same questionnaire was submitted again to 47 individuals of this same group to assess the reproductibility.

RESULTS

The scores of the instability showed that handicap increased with the age. The mean score for the 50-79 year-old group is almost four times greater that of the 20-49 years old. Correlation between scores and age is 0.70 for physical handicap, 0.76 for emotional handicap, 0.69 functional handicap and 0.83 for global score. There is no significant influence of sex. The reproductibility coefficient is 0.98.

CONCLUSION

The scores of the EHTEV increase with age. There is no significant influence of sex on scores and the coefficient of the reproductibility is good. But the translation of this handicap scale, need a study of validity and reliability.

Doença de Ménière e vertigem postural

OBJETIVO: A associação entre doença de Ménière e a vertigem postural tem sido descrita por vários autores. O objetivo deste estudo foi avaliar a presença do nistagmo de posicionamento e da sensação vertiginosa posicional em pacientes portadores de Doença de Ménière. FORMA DE ESTUDO: Clínico prospectivo. MÉTODO: Foram avaliados 44 pacientes com diagnóstico definitivo de doença de Ménière segundo avaliação clínica e audiológica (preenchendo os critérios diagnósticos da American Academy of Otolaryngology) e confirmação da hidropisia endolinfática por eletrococleografia (relação SP/AP >30%). O estudo do nistagmo de posicionamento foi realizado por meio da manobra de Brandt-Daroff com utilização das lentes de Frenzel -13 dioptrias. O exame foi considerado alterado pela presença de nistagmo e/ou vertigem. RESULTADOS: Na pesquisa do nistagmo de posicionamento, 7 pacientes (16%) apresentaram nistagmo e vertigem, 23 (52,2%) apresentaram vertigem sem o registro de nistagmo, e 14 (31,8%) não apresentaram alteração alguma. Considerando a presença isolada de vertigem como alteração do exame e a presença de vertigem postural associada à presença de nistagmo postural, o total de alterações foi de 68,1% (30 pacientes) nesta amostra. CONCLUSÃO: A associação entre Doença de Menière e vertigem postural é relevante e sua real incidência dependerá dos critérios utilizados para definir esta associação. Neste trabalho, tanto o desencadeamento de nistagmo quanto de sensação vertiginosa à manobra de Brandt-Daroff foram considerados positivos para a constatação desta associação. Com esta metodologia, a presença de vertigem postural em pacientes com Ménière foi de 68%.

Prevalence of Meniere disease in Finland

OBJECTIVES

To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommendation.

STUDY DESIGN

Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) in seven Finnish hospitals serving a population of 1.5 million people.

METHODS

Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re-evaluated. Definite cases according to AAO-HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996.

RESULTS

A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P<.001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000).

CONCLUSIONS

The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.

Initial symptoms and retrospective evaluation of prognosis in Menière's disease

Clinical studies on an initial symptom and a long-term course of vertigo and hearing impairment and retrospective evaluation of the prognosis were performed in Menière's disease. One hundred and fifty-one patients (67 males and 84 females) with Meniere's disease were treated in the Neuro-otological clinic, Kitasato University Hospital from 1990 to 1995. Ages ranged from 17 to 77 years (mean 47.3 years) at the onset of the disease when the first vertigo attack occurred. There were 106 (70.1%) in their 30s, 40s and 50s, and 28 (18.5%) aged 60 years or over. Seventy-eight patients visited the clinic within one year of the onset of the disease, but the mean interval was 4 years and 5 months (the longest was 25 years). The mean duration time for the follow-up studies from the time of their first visit to the hospital was 2 years and 5 months. The bilateral ears were invaded in 19 patients (12.6%) and the mean length of their time course was 9 years and 10 months which is longer than the length in unilateral cases. Several important key points for diagnosis of Menière's disease were investigated in 28 of the 151 cases who had been followed up successfully over a relatively long time course (the mean follow-up time was 7 years and 3 months). Fluctuated or stational cochlear signs, such as tinnitus, hearing impairment and/or fullness in the ear, had started prior to the onset of the first vertigo attack in 17 (61%) of 28 cases. Vertigo without cochlear sign appearing at the onset and cochlear signs were combined later in six (21%) of the 28 cases. Only five (18%) of the 28 cases had vertigo combined with a cochlear sign simultaneously at the onset of the disease. The affected ear was on the left in 15 cases and on the right in seven of 22 unilateral cases. In six bilateral cases the left ear was the first to be invaded in four out of six cases. The interval between the first and second attacks was over 1 year in six of the 28 cases and over 6 months in 10 of the 28 cases. Nine out of the 28 patients had recurrence of vertigo attacks during the first month and five of the nine had a cluster of attacks in the first month. Our study of 28 patients over a long time course revealed eight patients (28.6%) free from the disease. These patients had no recurrence of vertigo for more than 2 years after their last attack, and sixteen (57.1%) of the 28 patients had no recurrence of vertigo for more than 1 year. However, a long period of relief time of more than 2 years in 11 of the 28 patients and a period of more than 1 year was noticed in 16 of the 28 patients. Hearing levels at the middle and low frequencies in the first hearing test were compared with the last test. The mean of hearing levels changed from 38.1 to 36.2 dB after 2 years and 1 month in six cases with the right ear affected and from 34.1 to 45.3 dB after 5 years and 3 months in 15 cases with the left ear affected, but in seven cases with bilateral diseased ears the hearing in both ears became worse, from 25.5 to 57.1 dB in the right ear and from 30.5 to 53.6 dB in the left ear during a period of more than 10 years. These clinical findings should be utilized for diagnosis at the onset of Menière's disease to determine the interval for observation in order to evaluate the efficacy of treatment.