Natural history of Menière's disease: staging the patients or their symptoms?

The issue of what can be considered "natural" in the evolution of Menière's disease is reassessed in terms of basic assumptions regarding the definition of this inner ear disorder. Strict principles for the identification of Menière's patients are recommended; i.e. episodic vertigo, fluctuating-ascending hearing loss and tinnitus, accompanied by a positive electrocochleographic pattern (summating/action potential ratio > 0.51). When considering the evolution of Menière's disease, it is worth stressing that almost all patients receive several different kinds of treatment which affect the natural course of the disease to different degrees. When staging the patients, a prodromic stage (Stage 0), with intermittent, isolated symptoms of variable duration, precedes the disabling stage (Stage I) with its full array of symptoms. Stage la can be distinguished from Stage Ib depending on the fluctuation in hearing and different therapeutic strategies can be proposed in order to reach the stabilised stage (Stage II). A limited number of patients are susceptible to either reverting into a disabling stage or progressing to Stage III, with possible involvement of the contralateral ear. We conclude that the full expression of the disease is a self-running course which can be only slightly modified by medical or surgical therapy but, instead, can be controlled by psychological counselling and dietary-hygienic principles.