Menieres' disease symptomatology in relation to the AAO-HNS 1995 guidelines

Aim. Meniere's disease (MD) is a complex progressive disorders of the inner ear characterized by sensorineural hearing loss, episodic vertigo, tinnitus and aural fullness. MD diagnosis is essentially clinical and specialized test equipment should not be required. In 1995 the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology - Head and Neck Surgery published recommended guidelines for the diagnosis of the MD (3) classifying it in certain, definite, probable and possible. It was the aim of this paper to determine, in a large series of subjects affected by MD according to the AAO-HNS 1995 criteria, the distribution of the different forms, their relationship with clinical paramters and the aspects of the evolution of the disease over time. Methods. The study group consisted of 384 consecutive subjects affected by MD according to the AAO-HNS 1995 guidelines. In each case we have carried out an exhaustive anamnesis regarding all the aspects of the disease and audiometric threshold. Results. According to AAO-HNS classification 228 subjects (59%) at the moment of the first control in our department were affected by definite MD, 30 (8%) by probable MD and 126 (33%) by possible MD. In this sample, among the 129 subjects of this group 90 (73%) were affected only by hearing loss and 36 (27%) only by vertigo. Age at the beginning of the disease was not different among definite, probable and possible forms while subjects affected by the certain MD were older and presented a longer duration of the disease. Disability level was lesser in the possible forms, condition in which the lower degrees are more represented. Among the 228 definite forms, MD appeared with both vertigo and hearing loss together (temporal delay less than 24 hours) in 79 cases (35%), with hearing loss alone in 96 cases (42%) and with vertigo alone in 53 cases (23%). PTA mean threshold at 0.5-1-2-3 kHz at the first control in the 228 cases of definite MD is worse than in the 90 subjects subjects affected by possible MD in its cochlear form. Conclusion. In conclusion definite form represents the most common form of MD at diagnosis and comprises the most disabling cases. However in the larger part of cases it begin as possible and transforms in definite later, normally within 5 years.