Case histories of patients with Meniere's disease were studied regarding character, duration, intensity of vertigo and length of the intervals of occurrence. The purpose of this study was to demonstrate of natural course of Meniere's disease and obtain criteria for the improvement of recurrence of vertiginous attacks by medical treatment, as distinct from spontaneous relief, following the natural course of the disease.
Forty patients diagnosed as having Meniere's disease were included in the study. The diagnosis was based on the criteria of diagnosis of Meniere's disease by Tokita et al. (1967).
During examinations of the natural course of Meniere's disease, the following types were observed.
(1) In 6 cases, a definitive spell appeared repeatedly in the same season once or twice every year.
(2) In 4 cases, a definitive severe spell with long intervals changed to a slight spell.
(3) In 5, there was a gradual decrease of recurrence of vertiginous attacks, with time.
(4) In 12, burst of spell occurred continuously from the time of onset.
(5) In 5, repetition of single definitive spell and burst of spell appeared with irregular alternation.
(6) In 2, Lermoyez's disease was finally diagnosed as Meniere's disease.
(7) There were two with a sudden deafness at onset.
(8) Nine experienced vertigo induced by transient ischemic attacks or orthostatic dysregulation before the onset of Meniere's disease.
The natural course of Meniere's disease varied with the individual. The longest period without attack of vertigo by spontaneous relief following natural course of the disease was from 1 month to 8 years. Thus, it was most difficult to determine the improvement of vertigo by medical treatment, as distinct from spontaneous relief. For determination of the improvement of vertigo by medical effects, abscence of a spell for 10 times the average interval before treatment (criteria by American Academy of Ophthalmology and Otology) and for 3 times of the longest period without attack of vertigo before treatment are required.
