Time, surgery appear to reduce episodes of dizziness in patients with Ménière's disease

November 17, 2008

Episodes of dizziness tend to become less frequent over time in patients with Ménière's disease, a condition characterized by vertigo, hearing loss and ringing in the ears, according to a report in the November issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals. A second report finds that a surgical procedure to drain fluid from the inner ear appears to reduce vertigo in three-fourths of patients with the condition.

Several studies have outlined how hearing loss and tinnitus (ringing in the ears) progress over time in patients with Ménière's disease, according to background information in the article. "Hearing loss increases during follow-up until it reaches a moderate or severe level, and, similarly, tinnitus becomes constant, causing a decrease in the health-related quality of life in many individuals," the authors write. "However, the time course of episodes of vertigo [dizziness] is less clear, even though the primary goal of treatment is to decrease the frequency and duration of these episodes."

Herminio Perez-Garrigues, M.D., Ph.D., of Hospital Universitario La Fe, Valencia, Spain, and colleagues studied 510 individuals from eight hospitals who met criteria for definitive Ménière's disease between 1999 and 2006. The patients were given conservative care and followed through 2006 to evaluate the frequency and duration of vertigo through the course of the disease.

"Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life," the authors write. "The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than six hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease."

The percentage of patients with no episodes of vertigo increases as the disease progresses, and 70 percent of patients who did not have vertigo during any one year also did not have any episodes in the following year. "In contrast, the likelihood that patients who had episodes of vertigo continued to have them was slightly greater than 50 percent," the authors write.

"This may mean that the activity of the etiologic factor causing the episodes persists for a few months and then ceases to be active," they continue. "However, the problem remains latent until this or another factor again alters inner-ear function. Logically, the evolution of Ménière's disease depends on certain unknown variables such as etiology and personal characteristics. After analyzing our results, we believe it would be interesting to study whether patients can be classified into groups with the same evolutionary process and to investigate the variable or variables that might define such groups."

In another study, Stephen J. Wetmore, M.D., of West Virginia University School of Medicine, Morgantown, reports on the results of endolymphatic sac surgery for patients with Ménière's disease who did not respond to more conservative therapies, such as low-sodium diets or diuretic medications. The surgery involves inserting a shunt into the endolymphatic sac in the inner ear and draining the fluid inside to relieve symptoms. Between 1989 and 2006, 51 patients underwent this surgery for the first time and 16 underwent revision surgery for recurring disease.

After 24 months, the surgery improved major spells of vertigo in 77 percent of patients undergoing the procedure for the first time and 65 percent of patients undergoing revision surgery. For those having revision surgery, results appeared better in patients who developed recurrent symptoms more than two years after than procedure than among those who failed treatment earlier.

"Endolymphatic sac surgery seems to be beneficial in regard to decreasing or eliminating major dizzy spells in those patients who continue to have frequent and severe dizzy spells despite maximal medical therapy," Dr. Wetmore concludes. "For those patients who initially do well after sac surgery but who experience recurrence of symptoms later, revision surgery is often beneficial. The longer the interval between primary endolymphatic sac surgery and the revision procedure, the more likely it is that the patient will obtain a beneficial response from the revision surgery."
(Arch Otolaryngol Head Neck Surg. 2008;134[11]: 1149-1154, 1144-1148. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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