Diagnosis, Differential ; Humans ; Meniere Disease ; diagnosis ; therapy ; Vertigo ; diagnosis ; therapy

OBJECTIVE: To compare the features of caloric tests in vestibular migraine (VM) and Menière's disease (MD) patients, and provide objective evidence for differentiating the 2 groups of patients. METHOD: This case-control study included 11 MD patients with left ear involved and mild to moderate impaired hearing, and 18 matched cases with VM. All participants received caloric tests. Maximum slow phase velocities (SPVmax) were used to describe horizontal and vertical nystagmus respectively and were compared between the 2 groups. Horizontal and vertical canal parasis(CP) were calculated according to respective SPVmax. Unilateral (UW-VR) or bilateral (BW-VR) weakness of vestibular response, and positive unilateral (UVR) or bilateral (BVR) vertical response or negative bilateral vertical response (NBVR) were judged by the boundary point of SPVmax of 5°/s respectively. Total left (LV) or right (RV) Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses (IED-VR) calculated from LV minus RV. RESULT: There were no significant differences in age and gender between the 2 groups. Horizontal SPVmax of all of caloric tests of VM group,except the left cold (LC), were statistically larger than that of MD group (P < 0.05) and the maximum responses of right warm (RW) caloric test in VM group (34.50 ± 17.77) were significantly greater than that in MD group (12.82 ± 6.69) (P < 0.01). Only the vertical SPVmax of RW of all caloric tests has statistically difference between the 2 groups (P < 0.01), and the maximum responses of RW caloric test in VM group (6.00 ± 4.45) were significantly stronger than that of LC in MD group (1.27 ± 2.00) (P < 0.01). Horizontal CP ≥ 25% of the 2 groups(VM: 72.22%, MD: 54.55%) were not statistically different, while the proportions of UW-VR and BW-VR in VM group (5.56%, 0) were significantly lower than that in MD group (27.27%, 18.18%) (P < 0.05). Vertical CP ≥ 25% of the 2 groups (VM: 94.44%, MD: 27.27%) were significantly different (P < 0.01), and the proportions of positive UVR (left: 5.56%, right: 77.78%) and BVR (0) and NBVR (16.67%) in VM group were significantly different from that in MD group (UVR (left: 9.09%, right: 0), BVR (0), NBVR (90.91%)) (P < 0.01). There was statistically difference between LV and RV in VM group (P < 0.01, LV < RV), while no difference were showed in MD group. IED-VR in VM group (left intenser: 16.67%, right intenser: 83.33%) was statistically different from that in MD group (left intenser: 36.36%, right intenser: 9.09%, both no difference: 54.55%) (P < 0.01). CONCLUSION Vestibular responses of caloric test are more sensitive, and vertical reactions are more easily induced in VM patients than in MD. Caloric test can be used to differentiate the 2 groups of diseases.
Caloric Tests ; Case-Control Studies ; Diagnosis, Differential ; Humans ; Meniere Disease ; diagnosis ; physiopathology ; Migraine Disorders ; diagnosis ; physiopathology

OBJECTIVES: Over the last decades, numerous studies on the effect of vestibular rehabilitation (VR) have been reported in western countries, but there has been no report about real experiences of customized VR in Korea. The aim of this study was to analyze of the efficacy, compliance and satisfaction in patients with acute and chronic dizziness. METHODS: Patients with dizziness were treated with a customized VR at least 4 weeks. Subjects were assessed before and after at least 4 weeks of customized VR for visual analogue scale (VAS) and disability scale (DS). Patients were asked to score the satisfaction of their treatment as 1 (very poor) to 5 (excellent). Compliance to exercise program were graded as 1 (regularly performed), 2 (frequently performed), or 3 (rarely performed). RESULTS: Thirty-two patients with dizziness were included. Diagnosis of patients were vestibular migraine (n=5), Meniere's disease (n=2), vestibular neuritis (n=10), persistent perceptual positional dizziness (n=10), bilateral vestibulopathy (n=3), and central dizziness (n=2). Mean VAS and DS before VR were 15.3 and 2.4, respectively. Mean VAS and DS after VR were 4.5 and 0.7, respectively. Significant improvements in VAS and DS were observed after VR (p=0.00). Mean treatment satisfaction score was 3.3±1.0 and mean compliance score was 2.3±0.8. Satisfaction to VR showed positive correlation with patient's compliance. (p=0.00, r=0.644) CONCLUSIONS: Significant improvements were seen in symptom and disability in patients with acute and chronic dizziness after customized VR. Patients showed moderate compliance to exercise program and overall satisfaction was fair.
Compliance ; Diagnosis ; Disease Management ; Dizziness ; Humans ; Korea ; Meniere Disease ; Migraine Disorders ; Rehabilitation ; Vestibular Diseases ; Vestibular Neuronitis

Humans ; Meniere Disease ; diagnosis ; etiology ; Vascular Diseases ; complications ; Vertigo ; diagnosis ; etiology

BACKGROUND AND OBJECTIVES: There is no single test that is definitive for making the diagnosis of Meniere's disease. However, electrocochleography (ECoG) has been advocated as a reliable objective test for Meniere's disease. This study was undertaken to assess the clinical characteristics among patients of Meniere's diseases, who are divided into different groups, and the value of ECoG in establishing the diagnosis and classification of Meniere's disease. MATERIALS AND METHOD: From Jan 1990 to Dec 1999, 126 patients clinically suspected of unilateral Meniere's disease and who had undergone ECoG were selected. Patients were classified into definite, probable and possible Meniere's groups. The lowest audiological thresholds from the previous 6 months, the SP:AP ratio and the results of a caloric test were evaluated, retrospectively. RESULTS: The definite Meniere's group demonstrated an elevated SP:AP ratio among 74.4% of the cases, the probable Meniere's group among 48.6%, and the possible group among 37.0%. However, symptoms such as tinnitus or earfullness showed no correlation between the groups. According to the audiologic evaluation, the possible group was mostly in the stage I, whereas the definite group and probable group were mostly in the stage III. The audiogram pattern and the caloric test showed no difference among the groups. CONCLUSION: ECoG showed no correlation with the stages of Meniere's disease. However, ECoG can be helpful in differential diagnosis of definite Meniere's group from probable or possible group.
Audiometry ; Audiometry, Evoked Response* ; Caloric Tests ; Classification ; Diagnosis ; Diagnosis, Differential ; Humans ; Meniere Disease* ; Retrospective Studies ; Tinnitus

OBJECTIVE: To investigate the incidence of anxiety and depression state in patients with Meniere's disease, to provide objective evidence for curing Meniere's disease effectively. METHOD: Hamilton anxiety scale and Hamilton depression scale were used to quantitatively analyze the anxiety and depression state of 60 patients with untreated definite Meniere's disease and 20 normal controls. RESULT: The scores of patients with Meniere's disease was significantly higher than that of normal controls (P < 0.05). There was no significant difference in scores between the males and females in Meniere's disease patients (P > 0.05). CONCLUSION Patients with Meniere's disease experienced high level of anxiety and depression. The treatment should not only focus on the physiological disorder but also the psychiatric and emotional problems.
Anxiety ; diagnosis ; Depression ; diagnosis ; Female ; Humans ; Male ; Meniere Disease ; psychology ; therapy ; Psychiatric Status Rating Scales

Objective:To investigate the characteristics of wideband acoustic immittance（WAI） measurements in patients with unilateral Ménière's disease（MD） and evaluate the clinical value of WAI in diagnosis of MD. Methods:WAI was performed in 30 patients with unilateral MD（30 ears for symptomatic and 30 ears for asymptomatic） and in 26 healthy individuals（52 ears）（control group）. The WAI measurements, including the frequency first appearing two peaks in energy absorbance（EA） tympanogram, resonance frequency（RF）, the peak value of absorbance（PVA）, the integral area of absorbance（IAA）, EA curve at peak pressure, were analyzed. Results:①The occurrence of two peaks in EA tympanogram in both the MD symptomatic and asymptomatic ear was observed in 27 ears（84.4%）, and 38 ears（70.4%） in the control group, with no significant difference in the frequency of first appearing in two peaks onset between the groups（all P>0.05）. ②The RF of the MD symptomatic ears was significantly lower than that of the asymptomatic ears（t=-3.544, P=0.001） and that of the control subjects（t=2.084, P=0.041）; there was no difference of RF between the MD asymptomatic ears and the control group（P>0.05）. ③The PVA were significantly lower in both MD symptomatic（t=4.240, P<0.01） and asymptomatic ears（t=4.202, P=0.001） than in controls. ④The IAA in MD symptomatic（t=3.295, P=0.001） and asymptomatic ears（t=3.193, P=0.003） was significantly lower than in the control group. ⑤Comparison of the EA curve at peak pressure of the three groups: the EAs of MD symptomatic ears were lower than those of the control group at the range of 1 059-2 911 Hz（all P<0.05）; the EAs of MD symptomatic ears were lower than those of MD asymptomatic ears within 1 000 Hz and 1 834-2 119 Hz（all P<0.05）; the EAs of MD asymptomatic ears were lower than those of the control group at the range of 515-2 748 Hz（all P<0.05）. Conclusion:Symptomatic ears in unilateral MD patients show alterations in some WAI measurements compared to asymptomatic ears and/or controls, suggesting that middle ear mechanical fuction of the affected side may be modified due to the endolymphatic hydrops. The clinical significance of WAI needs to be further explored in the context of evaluating MD.
Humans ; Meniere Disease/diagnosis* ; Endolymphatic Hydrops/diagnosis* ; Ear ; Hearing Tests ; Acoustics

BACKGROUND AND OBJECTIVES:The guidelines for Meniere's disease recommended from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995, provided a basis for reporting results of the treatment used in Meniere's disease. However, these guidelines are sometimes not all inclusive and appropriate for management and reporting for some patients clinically considered having Meniere's disease. The objectives of this study is to review and analyze the symptoms, vertiginous episodes, audiometry, vestibular function test and results of the treatment in Meniere's disease and to evaluate the significance of AAO-HNS guidelines. MATERIALS AND METHOD:This study consisted of the patients with Meniere symptoms who visited the Dizziness Clinic of Ajou University Hospital between 1994 and 2001 were included in this study. The characteristics of dizziness (duration, frequency, and episodes), pure tone audiometry, vestibular function tests, and treatment results were carefully analyzed according to AAO-HNS guidelines. RESULTS:Of 550 patients with Meniere symptoms, 198 patients were in the criteria for Meniere's disease. They were classified to 75 (37.9%) of the "definite", 120 (60.6%) of the "possible", and only 3 (1.5%) of the "probable". In the "definite" group, the pure tone average (PTA) was 54.3 dB and canal paresis (CP) was showed in 33 patients (44%) with a mean CP of 53.6%, and the peak and descending types of the pure tone audiogram were dominant (62%). In the "possible" group, the PTA was 19.4dB and CP was found in 30 patients (25%) with mean CP of 50.1%. CONCLUSION:Even though AAO-HNS guidelines for Meniere's disease are helpful for communication between doctors, they should be considered to have limitations for the diagnosis and treatment in clinical practices.
Audiometry ; Diagnosis ; Dizziness ; Hearing ; Humans ; Meniere Disease* ; Neck ; Paresis ; Vestibular Function Tests

OBJECTIVES: In Meniere's disease, medical treatment using diuretics has been the mainstream of management. But the effects of medical treatment are very difficult to evaluate because of many variables. Authors tried to investigate the effects of diuretics on Meniere's disease through the change of symptoms. MATERIALS AND METHOD: From January, 1995 to December, 2000, the twenty patients with definite Meniere's disease who has been followed up over 24 months were retrospectively reviewed. They had no history of previous medication, and were managed with diuretics for the first time. The change of frequency of vertigo, the threshold of pure tone audiometry, type of audiogram were analyzed at each period during 6 month before treatment, during 6 month at 1, 2 and 4 years after treatment. RESULTS: The ratio of sex was 1:1(male 10, female 10), the average age of diagnosis was 53.9 year old, and the average follow up duration was 39.3 month. By medical treatment, vertigo symptom was significantly controlled in 56.2% at 2 year after treatment. Among 20 patients, 5 patients failed to medical treatment and underwent the sac decompression (N=1) and intratympanic gentamicin injection (N=4). The change of pure tone audiometry was from 34.5 dB before treatment to 38 dB at 24 months and 44.2 dB at 48 months after treatment. The most type of audiometry was flat type and flat type was increased with time. CONCLUSION: In Meniere's disease, the medical treatment controlled significantly the vertigo frequency in 50~60%. But the hearing threshold was aggravated with time after treatment despite of medical treatment.
Audiometry ; Decompression ; Diagnosis ; Diuretics ; Female ; Follow-Up Studies ; Gentamicins ; Hearing ; Humans ; Meniere Disease* ; Retrospective Studies ; Vertigo

BACKGROUND AND OBJECTIVES: Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. MATERIALS AND METHOD:Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. RESULTS:Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. CONCLUSIONS:Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.
Aged* ; Diagnosis, Differential ; Dizziness ; Ear, Inner ; Hearing Loss ; Humans ; Meniere Disease ; Paresis ; Pathology ; Surveys and Questionnaires ; Syncope*