A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests

Abstract

To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in "grading" the severity of MD.

Keywords: Menière's disease; dizziness handicap inventory; rotatory chair test; vestibular-evoked myogenic potential; video head impulse test.

Figure 1

Selection process.

Figure 2

Correlations between Dizziness Handicap Inventory (DHI) scores and number of involved vestibular end organs. The DHI (A), DHI-P (B), and DHI-F (C) scores positively correlate with the number of involved vestibular end organs.

Figure 3

The number of vertigo attacks is positively correlated with the number of involved vestibular end organs.

Figure 4

The number of involved vestibular end organs is negatively correlated with the vestibulo-ocular reflex (VOR) gains of anterior (A) and posterior (B) semicircle canals tested in video head impulse test (vHIT) and is positively correlated with interaural asymmetry ratios in vestibular-evoked myogenic potentials (VEMPs) (C,D). The range of error bars is the expression of 95% confidence interval.

Figure 5

The vestibulo-ocular reflex (VOR) gain of the rotatory chair test (RCT) at 0.08 Hz significantly correlates with the Dizziness Handicap Inventory–physical (DHI-P) score (A) and number of vertigo attacks in the past 6 months (B).

Figure 6

Categorization of study participants with Menière's disease (MD) based on the involved parts of the inner ear (A). The involvement of the cochlea was labeled as the C (cochlea) type pathology in all subjects. Similarly, the involvement of the saccule, utricle, and semicircular canals (SCs) was labeled as the S-, U-, or D-type pathology, respectively. In the D type, the involvement of a specific SC was labeled by the suffix H, P, and A for H-SC, P-SC, and A-SC, respectively. The type and percentage of participants for each type out of the total study population are presented inside each box. The percentages of participants with each Dizziness Handicap Inventory (DHI) level relative to the total population of this type are listed beside each box. Moreover, the patients with the involvement of different SCs are listed as percentages out of the total sample. Except for three types with only one patient, DHI score and the number of the involved vestibular end organs are increased clockwise (B); the range of error bars is the expression of 95% confidence interval.