Chul Ho Shin1, Yehree Kim1, Myung Hoon Yoo2, Tae Su Kim3, Jun Woo Park1, Byung Chul Kang4, Hong Ju Park1. 1. Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul. 2. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu. 3. Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University School of Medicine, Chuncheon. 4. Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Abstract
OBJECTIVE: To report the incidence of vestibular migraine (VM) in patients with Ménière's disease (MD) and investigate whether management outcomes of MD differ by the association of VM. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care academic center. PATIENTS: MD patients (n = 251) with/without VM who were managed for 5 years in a dizziness clinic. MAIN OUTCOME MEASURES: Influence of VM on management outcomes and hearing at the latest follow-up in stepwise management options. RESULTS: Incidence of VM was 35% in MD patients. VM was more common in women than men (40 vs. 22%) and in probable MD than definite MD (43 vs. 29%). Bilateral MD was more frequent with coexistence of VM than without VM in definite MD (14 vs. 0%) as well as probable MD (24 vs. 7%). At the latest follow-up, preventive medications were effective in controlling vertigo in most (80%) patients (74%/90% in definite/probable MD). Additional intratympanic steroids were required in 16% (20%/10% in definite/probable MD) and intratympanic gentamicin or surgeries in 9 (6%) patients with intractable MD. The percentage of intractable MD did not differ with coexistence of VM, though definite MD showed a significantly higher percentage of intractable MD than probable MD (6 vs. 0%, respectively, p = 0.002). Worsening hearing was more frequent in definite MD than probable MD (19 vs. 4%), and association of VM did not influence the incidence of worsening hearing. CONCLUSIONS: Coexistence of VM was about 30 to 40% in definite and probable MD, especially frequent in bilateral MD (77%) and women with probable MD (50%), requiring identification of coexisting VM while managing MD patients. Management outcomes and worsening hearing in MD patients are not dependent on the coexistence of VM, when both are managed.
OBJECTIVE: To report the incidence of vestibular migraine (VM) in patients with Ménière's disease (MD) and investigate whether management outcomes of MD differ by the association of VM. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care academic center. PATIENTS: MD patients (n = 251) with/without VM who were managed for 5 years in a dizziness clinic. MAIN OUTCOME MEASURES: Influence of VM on management outcomes and hearing at the latest follow-up in stepwise management options. RESULTS: Incidence of VM was 35% in MD patients. VM was more common in women than men (40 vs. 22%) and in probable MD than definite MD (43 vs. 29%). Bilateral MD was more frequent with coexistence of VM than without VM in definite MD (14 vs. 0%) as well as probable MD (24 vs. 7%). At the latest follow-up, preventive medications were effective in controlling vertigo in most (80%) patients (74%/90% in definite/probable MD). Additional intratympanic steroids were required in 16% (20%/10% in definite/probable MD) and intratympanic gentamicin or surgeries in 9 (6%) patients with intractable MD. The percentage of intractable MD did not differ with coexistence of VM, though definite MD showed a significantly higher percentage of intractable MD than probable MD (6 vs. 0%, respectively, p = 0.002). Worsening hearing was more frequent in definite MD than probable MD (19 vs. 4%), and association of VM did not influence the incidence of worsening hearing. CONCLUSIONS: Coexistence of VM was about 30 to 40% in definite and probable MD, especially frequent in bilateral MD (77%) and women with probable MD (50%), requiring identification of coexisting VM while managing MD patients. Management outcomes and worsening hearing in MD patients are not dependent on the coexistence of VM, when both are managed.