L Frejo1, E Martin-Sanz2, R Teggi3, G Trinidad4, A Soto-Varela5, S Santos-Perez5, R Manrique6, N Perez6, I Aran7, M S Almeida-Branco8, A Batuecas-Caletrio9, J Fraile10, J M Espinosa-Sanchez1,11, V Perez-Guillen12, H Perez-Garrigues12, M Oliva-Dominguez13, O Aleman14, J Benitez15, P Perez16, J A Lopez-Escamez1,17. 1. Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain. 2. Department of Otolaryngology, Hospital Universitario de Getafe, Getafe, Spain. 3. Department of Otolaryngology, San Raffaelle Scientific Institute, Milan, Italy. 4. Division of Otoneurology, Department of Otorhinolaryngology, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain. 5. Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain. 6. Department of Otolaryngology, Clinica Universidad de Navarra, Pamplona, Spain. 7. Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. 8. Department of Otolaryngology, Hospital de Poniente, El Ejido, Almería, Spain. 9. Department of Otolaryngology, Hospital Universitario Salamanca, Salamanca, Spain. 10. Department of Otolaryngology, Hospital Miguel Servet, Zaragoza, Spain. 11. Department of Otorhinolaryngology, Hospital San Agustin, Linares, Jaen, Spain. 12. Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain. 13. Department of Otorhinolaryngology, Hospital Costa del Sol, Marbella, Malaga, Spain. 14. Department of Otolaryngology, Hospital General Universitario de Alicante, Alicante, Spain. 15. Department of Otolaryngology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain. 16. Department of Otorhinolaryngology, Hospital Universitario de Cabueñes, Gijon, Spain. 17. Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universidad de Granada (CHUGRA), Granada, Spain.
Abstract
OBJECTIVES: To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN: A cross-sectional study with a two-step cluster analysis. SETTINGS: A tertiary referral multicenter study. PARTICIPANTS: Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES: best predictors to define clinical subgroups with potential different aetiologies. RESULTS: We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS: Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.
OBJECTIVES: To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN: A cross-sectional study with a two-step cluster analysis. SETTINGS: A tertiary referral multicenter study. PARTICIPANTS: Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES: best predictors to define clinical subgroups with potential different aetiologies. RESULTS: We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS: Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.
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