Patient Perceptions of Effectiveness in Treatments for Menière's Disease: a National Survey in Italy

Abstract

Objectives: The aim of the present study was to investigate current treatment practices and self-reported effectiveness in Ménière's disease.

Materials and methods: Members of two Italian Ménière's disease support (n=170) with ≥6-month history of Ménière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life, work, or travel as included in the Social Life and Work Impact of Dizziness Questionnaire before and after recent treatments were queried.

Results: Twenty-four different treatments were reported for Ménière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being the most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments, 78%-89% of respondents indicated limitations in family or social life, work, or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6±4.6, p<0.001), days off work per month (10.1±9.2 vs. 4.2±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (p<0.05 for all). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (p<0.01 for all), as well as the fewest respondents reporting post-treatment functional limitations (16%-37%).

Conclusion: Despite many treatment approaches targeting different proposed pathophysiology for Ménière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Ménière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Ménière's disease.

Figure 1

Mean (SD) episodes of vertigo per month before and after treatment, by treatment group.

Figure 2

Mean (SD) number of days off work per month due to Ménière’s disease before and after treatment, by treatment group.

Figure 3

Proportion of all respondents reporting limitations in each SWID-4 question before and after treatment.

Figure 4

Proportion of respondents reporting limitations in working life and social activities before and after treatment, by treatment group. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001.

Figure 5

Proportion of respondents reporting limitations in family life and traveling ability before and after treatment, by treatment group. ns, not significant, *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001.***p<0.001, ****p<0.0001.