Comparison of the Risk of Exacerbation of Endolymphatic Hydrops between Patients with Recurrent Meniere’s Disease Receiving Continuous and Intermittent Treatment: A Retrospective Study

Abstract

In the present study, we attempted to clarify which could be a more effective way of treating Meniere’s disease — treatment carried out only during the attacks (intermittent group) and treatment administered continuously even during periods of remission (continuous group). We enrolled 77 cases of unilateral Meniere’s disease with a history of recurrent vertigo attacks who visited the Vertigo/Dizziness center of Nara Medical University. The patients underwent inner-ear gadolinium-enhanced MRI between June 2014 and March 2022. Of the 77 cases, 73 were divided into the intermittent group (n = 34) and the continuous group (n = 39). Medication included mainly osmotic diuretics, adenosine triphosphate, and vitamin B12, prescribed for oral intake three times per day. The vertigo frequency, modified Dizziness Handicap Inventory (mDHI) score, and hearing level were assessed, and the endolymphatic space (ELS) ratio was calculated on contrast-enhanced MR images for each patient.

The ELS ratios and hearing levels in the affected ear were significantly lower in the intermittent group than in the continuous group, especially in the whole inner ear, cochlea and vestibule. There was no significant difference in the vertigo frequency or mDHI between the intermittent and continuous groups. These results suggest that intermittent treatment just during the vertigo attacks may be more effective to prevent exacerbation of endolymphatic hydrops and preserve the hearing level than continuous treatment. These preliminary findings from the present retrospective study could provide insight for the development of treatment guidelines for Meniere’s disease in the future.