Clinical indicators useful in predicting response to the medical management of Meniere's disease

Abstract

Objectives: To identify factors that may correlate with responsiveness to medical management of Meniere's disease. Study Design: Retrospective chart review. Methods: The 1995 guidelines of the American Academy of Otolaryngology - Head and Neck Surgery (AAOHNS) Committee on Hearing and Equilibrium were used for data acquisition and measuring clinical response. New patients with 2 years' follow-up were evaluated and grouped as either medically or surgically treated. Patients were excluded for inadequate follow-up or prior otological surgery. Dietary sodium restriction ( < 1500 mg/d) and a diuretic were employed initially. A compliance rating system was devised to evaluate diet adherence. Patients whose medical management failed were offered surgery. Results: Of 65 patients reviewed, 29 patients qualified for analysis. Seventeen patients were treated medically (patients had either definite or possible Meniere's disease), and 12 patients required surgery. Patients with definite Meniere's disease were at a higher stage (based on audiogram) than patients with possible Meniere's disease (P = .002). Patients who required surgery for Meniere's disease were at a higher stage than patients with either definite or possible disease (P < .001). Patients with definite disease had lower compliance than patients with possible disease (P = .004), but both groups showed symptom improvement. Patients with possible disease had better control than patients with definite disease (P < .001). Hearing was stabilized in patients with possible disease and improved at 500 Hz in patients with definite disease (P = .04). Conclusions: Sodium restriction and diuretic treatment response are correlated to clinical measures of Meniere's disease. Patients with possible Meniere's disease should be treated with aggressive medical therapy to prevent disease progression.