THE FOLLOW-UP OF THE CONSERVATIVE MEDICAL TREATMENT OF PATIENTS SUFFERING FROM MÉNIÈRE’S DISEASE
Molnár A., Tamás L., Szirmai Á. Budapest, Hungary
Ménière’s disease (MD) is a disorder of the inner ear, characterized by episodic rotational vertigo, sensorineural hearing loss, tinnitus, aural pressure and vegetative symptoms, such as nausea and vomiting. Since the improvement of these symptoms exerts influence over the patients’ quality of life and the condition seems to be incurable, the symptomatic conservative treatment suggests an important question.
The aim of our study is to evaluate how we could provide periods without complaints at the tertiary referral otoneurologic centre of our clinic. According to our assumption the administration of different pharmacologic agents of the conservative treatment results insignificant improvement in the symptomatic condition of the patients with MD.
Materials and methods
To verify the truth of our supposition 105 (31 male and 74 female, mean SD age,57.4 11.05) patients with definite Ménière’s disease according to the diagnostic scale of the American Academy of Otolaryngology-Head and Neck Surgery were enrolled in this retrospective study. Beside the analysis of the hospital records, the subjective complaints of the patients and the completed dizziness diaries were taken into consideration too. The typical following of the subjects were 47.6 months 33.8, meanwhile 5 controls became due on average.
According to the diaries, our patients reported about 1552 episodes of dizziness and 52.7% of these episodes seemed to be described as rotational vertigo, the frequency of which was 2.35 1,4 attacks per month on average. The intermittent attacks of vertigo lasted 6.16 hours and the power of it 5.46 1,7 on a scale of one to ten. The mean value of the intensity of the tinnitus appeared to be 4.46 2.3 on a scale of ten and headache was associated with the episodes in 82% of the cases. Betahistine, the agent widely used in Europe as a first line treatment for MD seemed to be successful in the conservative treatment of the symptoms according to our observations. The mean dose in the symptomatic treatment seemed to be 87.5 27.2 mg per day, however, no apparent connection was found between the dose of the agent and the symptomatic control. For the vestibular status in 84 cases the use nootropics in a tablet form was required and in 50 cases as course of infusions. The application of intratympanal steroid (dexamethasone) injection was necessary in 22 cases, while the use of intratympanal gentamycin – only in 8 patients.
In spite of there not being a gold standard in the treatment of Ménière’s disease, we can still do a lot for the improvement of the quality of life of MD patients.