Characteristics of the Cochlear Symptoms and Functions in Meniere's Disease

Abstract

Background:Meniere's disease is a unique, progressive disease of the inner ear. The complex manifestation presents diagnostic challenges. The cochlear symptoms often present before vertigo and tend to be ignored. This study aimed to analyze the characteristics of cochlear symptoms and functions associated with Meniere's disease to investigate the regularity of the development of this disorder.Methods:One-hundred fifteen patients who were diagnosed with definite unilateral Meniere's disease at the Hearing and Vestibular Clinic of the Department of Otorhinolaryngology of Beijing Tongren Hospital from August 2013 to November 2015 were recruited in this retrospective study. Initial symptoms, duration from initial symptoms to the diagnosis, hearing thresholds, audiogram patterns, and caloric test results were collected and analyzed for each patient. Data were analyzed using SPSS 13.0 statistical software by Spearman's correlation, Kruskal–Wallis H test, Chi-square test, and Fisher's exact test.Results:The average hearing threshold of these patients was 45.24 ± 18.40 dB HL. A majority of the patients (55.65%) were in Stage 3. The initial presentation of the disorder in 58 cases (50.43%) comprised only cochlear symptoms without vertigo. A weak, positive correlation was found between the degree of hearing loss and duration of the disease from initial symptoms to the diagnosis (rs = 0.288, P = 0.002). Upward-sloping, inverted “V,” downward-sloping, and flat pattern were the main audiometric patterns observed with a distinctive distribution between stages (P < 0.001). Based on the configurations of audiograms, the audiometric patterns had a weak correlation to the duration (rs = 0.269, P = 0.004), and there was a tendency of duration to rising from upward-sloping, inverted V, downward-sloping to flat pattern. (H = 10.024, P = 0.018). Frequencies of tinnitus in 56 patients (64.4%) were at the lowest points of the audiograms, i.e., the frequencies of the poorest hearing threshold. The patients at an advanced stage (Stage 3 [56] and Stage 4 [73]) exhibited a significantly higher abnormality of canal paresis than those at the earlier stages (Stage 1 [23] and Stage 2 [42]) (χ2 = 5.973, P = 0.015).Conclusions:Patients with definite Meniere's disease always have a moderate to severe sensorineural hearing loss before diagnosis. Cochlear symptoms are the most common initial presentation. With the progression of the duration, the hearing impairment becomes more severe and the distribution of the audiometric pattern is distinctive between stages.

Identification of early-stage Meniere’s disease as a cause of unilateral tinnitus

“…Tinnitus due to primary cochlear deficit caused by aging or cochlear deficit secondary to ototoxicity, acoustic traumas or instant noise exposure usually presented by high frequencies drop by pure tone audiogram ( Alsarhan, 2012 ), while most of the patients with MD especially in early stage represented with low frequencies drop ( Zhang et al., 2016 ); for that reason no ECochG was not recommended for patients in control group.…”

“…Many authors have reported that in MD, the cochlear symptoms often present before the vertigo and tend to be ignored ( Zhang et al., 2016 ), while the vertigo episodes are the most incapacitating feature of the disease and the patients’ major complaint ( Cunha et al., 2005 ); hearing loss is usually used to identify the stage of the disease ( Van RompaeyWatkinson and Clarke, 2018 ). Although the diagnosis of MD is primarily based on clinical findings according to the criteria in Table 1 , some tests can confirm the presence of endolymphatic hydrops, and the most important of these tests is electrocochleography (ECochG).…”

“…As shown in Table 1 , the presence of at least two definitive spontaneous episodes of vertigo or dizziness is an essential for the diagnosis of both definite and probable MD, and the vertigo appears after cochlear symptoms in most of the cases ( Zhang et al., 2016 ). Accordingly, this study investigated the incidence of MD in cases presenting with unilateral tinnitus accompanied by pure-tone audiometric pattern showing average low-frequency thresholds worse than the average high-frequency thresholds by more than 10 dB, since these cases may represent early stages of MD before the occurrence of the vestibular symptoms.…”

Diagnostinių Tyrimų Patikimumas Diagnozuojant Menjero Ligos Tipus

“…Diagnozės nustatymas remiasi tik klinikiniais kriterijais. Klausos pažeidimas yra reikšmingas požymis norint nustatyti ML, o audiometrija yra vienintelis instrumentinis, bet nespecifinis tyrimas nustatyti ML [8]. Norint paneigti Menjero ligos diagnozę svarbu diferencijuoti neabejotiną ML nuo tikėtinos ML.…”

Tinnitus perception mediates the relationship between physiological and psychological problems among patients

“…The prevalence of tinnitus in different regions is associated with various issues that affect the auditory system, including HL after infection-induced otosclerosis, middle ear dysfunction, impairment due to cochlear presbycusis (van Sonsbeek, Pullens, & van Benthem, 2015; Zhang, Liu, Wang, Jia, & Gu, 2016), sensorineural HL, and Meniérè’s disease (Alpini & Cesarani, 2006; Axelsson & Ringdahl, 1989; Bauer et al, 2017; Cima et al, 2018; Møller et al, 2010; Scholes & Ramakrishnan, 2015; Eggermont, Zeng, Popper, & Fay, 2012; Zoger, Svedlund, & Holgers, 2006). Therefore, tinnitus is now viewed as a complex phenomenon compounded by other factors.…”