The evolution of intractable Ménière's disease: attacks resolve over time

Area of Science:

• Neurology
• Otolaryngology
• Clinical Medicine

Background:

• Understanding the natural course of Ménière's disease (MD) is crucial for treatment decisions.
• The long-term evolution of vertigo attacks in MD is controversial.
• Conservative surgical approaches in Northern Europe necessitate strict patient selection.

Purpose of the Study:

• To investigate the natural temporal course of vertigo attacks in patients with intractable Ménière's disease.
• To evaluate symptom evolution in patients considered for, but not undergoing, surgery.

Main Methods:

• Retrospective cohort study at an expert Ménière's disease center.
• Inclusion of patients with definite unilateral MD and persistent vertigo despite intratympanic steroid injections.
• Data collection via patient files and follow-up telephone interviews assessing vertigo attack evolution.

Main Results:

• 35 patients were analyzed; 71% declined surgery.
• 64% of patients with complete data (n=33) were vertigo-free after a median of 5.3 years.
• Patients who underwent surgery had a longer disease duration than those who did not.

Conclusions:

• Intractable Ménière's disease patients often experience spontaneous symptom relief over time.
• The efficacy of non-ablative therapies is debated, and ablative interventions carry risks.
• Careful consideration of any active intervention is warranted due to potential long-term side effects.