Meniere's disease with unremitting floating sensation is associated with canal paresis, gravity-sensitive dysfunction, mental illness, and bilaterality
Meniere's disease with unremitting floating sensation is associated with canal paresis, gravity-sensitive dysfunction, mental illness, and bilaterality
复制标题
DOI：
10.1016/j.anl.2018.07.003
复制
发表时间：
2019-04-01
影响因子：
1.7
通讯作者：
Yamanaka, Toshiaki
中科院分区：
文献类型：
--
作者：
Kitahara, Tadashi;Sakagami, Masaharu;Yamanaka, Toshiaki
Objective: The aim of the present study was to evaluate the association of neuro-otological examination, blood tests, and scoring questionnaire data with treatment-resistant intractability of persistent dizziness in Meniere's disease.Methods: We managed 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to April 2018. Five hundred and twenty-two patients were diagnosed with Meniere's disease (522/1520; 34.3%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. Among the patients with Meniere's disease there were 102 with intractable rotatory vertigo attacks for more than 3-6 months (102/522; 19.5%), including 20 bilateral cases (20/102; 19.6%), and 88 with intractable unremitting floating sensation rather than rotatory vertigo attacks for more than 3-6 months (88/522; 16.9%), including 28 bilateral cases (28/88; 31.8%). Sixty out of 88 cases with intractable unremitting floating sensation were unilateral and were enrolled for hospitalization to undergo neuro-otological examinations including pure-tone audiometry (PTA), the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV) test, glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Data are presented as positive (+) ratios of the number of patients with examination and questionnaire data outside of the normal range.Results: The ratios (+) were as follows: C-test = 33.3% (20/60), cVEMP = 25.0% (15/60), SVV = 50.0% (30/60), G-test = 55.0% (33/60), ECoG = 63.3% (38/60), ieMRI = 86.7% (52/60), ADH = 35.0% (21/60), BAP = 11.7% (7/60), and SDS = 40.0% (24/60). Multivariate regression analysis revealed that the periods of persistent dizziness were significantly longer in unilateral Meniere's patients with C-test(+), SVV(+), and SDS(+) compared with those with negative findings. Additionally, the periods in bilateral cases were significantly longer than those in unilateral ones.Conclusions: Although approximately 70% of patients with Meniere' s disease are usually treatable through the appropriate conservative medical therapy, the presence of canal paresis, gravitysensitive dysfunction, neurosis/depression, and bilaterality may make the persistent dizziness intractable and may thus require additional treatments. (C) 2018 Elsevier B.V. All rights reserved.
