Definition: Ménière’s disease is an idiopathic inner ear disease that presents with recurrent episodes of rotational vertigo, fluctuating sensorineural hearing loss, tinnitus and a feeling of fullness in the ear. The basic pathological change of Ménière’s disease is the accumulation of fluid in the vagus of the inner ear membrane.
I. Diagnostic basis and clinical stage of Ménière’s disease
1.Diagnostic basis
(1) Episodes of rotational vertigo 2 or more times, each lasting 20 minutes to several hours. It is often accompanied by autonomic disorder and balance disorder. No loss of consciousness.
(2) Fluctuating hearing loss, mostly low-frequency hearing loss in the early stage, with progressive hearing loss gradually aggravated. At least 1 pure tone audiometry for sensorineural hearing loss, auditory resonance phenomenon may occur.
(3) With tinnitus and/or a sense of ear fullness.
(4) Vestibular function examination: there may be spontaneous nystagmus and/or abnormal vestibular function.
(5) Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, vaginitis, vestibular neuronitis, drug-induced vertigo, sudden deafness, insufficient blood supply to the vertebral basilar artery and intracranial occupying lesions.
2.Clinical stages.
(1) Early stage: normal intermittent hearing or mild low frequency hearing loss.
(2) Middle stage: intermittent low and high frequency hearing loss.
(3) Late stage: full-frequency hearing loss of moderate to severe or more, no hearing fluctuations.
3.Suspicious diagnosis (Meniere’s disease pending diagnosis).
(1) Only 1 episode of vertigo with pure tone audiometry for sensorineural hearing loss with tinnitus and ear fullness.
(2) 2 or more episodes of vertigo, each lasting 20 min to several hours. Hearing is normal without tinnitus and fullness.
(3) Fluctuating low-frequency sensorineural hearing loss. The phenomenon of reverberation may occur. No obvious vertigo attacks.
Any of the above is considered a suspicious diagnosis. Further glycerol test, cochlea electrogram, otoacoustic emission and vestibular function examination can be performed for those with suspicious diagnosis according to the conditions.
Evaluation of the efficacy of Meniere’s disease
(1) Evaluation of vertigo: The number of vertigo attacks between 18 and 24 months after treatment is compared with the average number of attacks per month in the 6 months before treatment, and the score is calculated as follows: score = number of attacks between 18 and 24 months after treatment / number of attacks in the 6 months before treatment × 100. The degree of vertigo is divided into 5 grades, namely: Grade A
0 points (complete control, not to be interpreted as “cure”); B grade 1~40 points (basic control); C grade 41~80 points (partial control); D grade 81~120 points (uncontrolled); E grade >120 points (aggravation).
(2) Hearing assessment: The average of the worst one hearing threshold (hearing level) of 0.25, 0.5, 1, 2 and 3 kHz within 6 months before treatment was assessed by subtracting the average of the worst one hearing threshold of the corresponding frequency 18~24 months after treatment. Hearing improvement was divided into 4 levels, namely: Grade A improvement >30dB or hearing threshold <20dB at each frequency; Grade B improvement 15~30dB; Grade C improvement 0~14dB (ineffective); Grade D improvement <0 (deterioration).
If the diagnosis is bilateral Ménière’s disease, it should be evaluated separately.
(3) Mobility assessment: The activity limitation days between 18~24 months after treatment were compared with the activity limitation days in the 6 months before treatment, according to: the obtained score = activity limitation days between 18~24 months after treatment M activity limitation days in the 6 months before treatment × 100 Mobility was divided into 5 grades, namely
Grade A: 0 points (complete improvement);
Grade B: 1~40 points (basic improvement);
Grade C: 41~80 points (partial improvement);
Grade D: 81~120 points (no improvement);
Grade E: >120 points (aggravation).
Attachment: Activity-limited days are the number of days with an activity score of 3 or 4 on that day.
Activity scores.
1. 0 points: no impairment of any activity.
2.1 point: activities mildly affected.
3.2 points: activities moderately affected, but no activity restricted.
4. 3 points: activity restricted, unable to work, must rest at home.
5.4 points: activities are severely restricted, bedridden all day or the majority of activities cannot be.