Moleon M D Carmen, Torres-Garcia Lidia, Batuecas-Caletrio Angel, Castillo-Ledesma Natalia, Gonzalez-Aguado Rocio, Magnoni Laura, Rossi Marcos, Di Berardino Federica, Perez-Guillen Vanesa, Trinidad-Ruiz Gabriel, Lopez-Escamez Jose A
Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta de Andalucía, PTS, Granada, Spain.
Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain.
Ear Hear. 2022 May/Jun;43(3):1079-1085. doi: 10.1097/AUD.0000000000001169.
Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement.
A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds. The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold >20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset.
Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL [area under the curve (AUC) = 0.641, p = 0.002]. The model was validated in the second cohort (AUC = 0.621, p < 0.001). Finally, we merged both datasets to improve the precision of the model including HFHL in the first audiogram (OR = 3.168, p = 0.001), migraine (OR = 0.482, p = 0.036) and age of onset >35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p < 0.001).
A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.
梅尼埃病（MD）由反复发作的自发性眩晕、耳鸣、耳胀满感和感音神经性听力损失（SNHL）的临床综合征定义。大多数患者为单侧SNHL，但部分患者在疾病过程中会出现对侧SNHL。多项研究报告称，根据疾病持续时间和随访时间，对侧SNHL的发生率为2%至73%。我们推测单侧和双侧MD是不同的疾病状态，前者最初累及耳蜗顶转，而双侧MD会影响耳蜗全长。本研究的目的是寻找MD中双侧SNHL的临床预测因素，以建立双侧受累的预测模型。
开展一项回顾性纵向研究，纳入两个队列，共400例确诊MD患者。起始队列由150例MD患者组成，验证队列包括250例。所有病例根据听力损失阈值诊断为单侧MD。评估以下变量作为两个队列双侧SNHL的预测因素：性别、发病年龄、MD家族史、偏头痛和高频听力损失（HFHL，定义为2至8kHz两个或更多连续频率的听力阈值>20dB）。根据首次听力图中HFHL的存在情况对主要变量进行描述性分析。通过多元逻辑回归，我们为起始队列建立了几个预测模型，并用复制队列和合并数据集进行验证。
起始队列和验证队列中，分别有23例（19.3%）和78例（41%）HFHL患者在随访期间出现对侧SNHL。在起始队列中，最佳预测模型包括首次听力图中的HFHL（OR = 6.985，p = 0.063）和无偏头痛（OR = 0.215，p = 0.
