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Frejo L, Martin-Sanz E, Teggi R, Trinidad G, Soto-Varela A, Santos-Perez S, Manrique R, Perez N, Aran I, Almeida-Branco MS, Batuecas-Caletrio A, Fraile J, Espinosa-Sanchez JM, Perez-Guillen V, Perez-Garrigues H, Oliva-Dominguez M, Aleman O, Benitez J, Perez P, Lopez-Escamez JA. Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis. Clin Otolaryngol 2017; 42:1172-1180. [PMID: 28166395 DOI: 10.1111/coa.12844] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 01/19/2023]
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.
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Affiliation(s)
- L Frejo
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain
| | - E Martin-Sanz
- Department of Otolaryngology, Hospital Universitario de Getafe, Getafe, Spain
| | - R Teggi
- Department of Otolaryngology, San Raffaelle Scientific Institute, Milan, Italy
| | - G Trinidad
- Division of Otoneurology, Department of Otorhinolaryngology, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - A Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - S Santos-Perez
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - R Manrique
- Department of Otolaryngology, Clinica Universidad de Navarra, Pamplona, Spain
| | - N Perez
- Department of Otolaryngology, Clinica Universidad de Navarra, Pamplona, Spain
| | - I Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - M S Almeida-Branco
- Department of Otolaryngology, Hospital de Poniente, El Ejido, Almería, Spain
| | - A Batuecas-Caletrio
- Department of Otolaryngology, Hospital Universitario Salamanca, Salamanca, Spain
| | - J Fraile
- Department of Otolaryngology, Hospital Miguel Servet, Zaragoza, Spain
| | - J M Espinosa-Sanchez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otorhinolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - V Perez-Guillen
- Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
| | - H Perez-Garrigues
- Department of Otorhinolaryngology, Hospital Universitario La Fe, Valencia, Spain
| | - M Oliva-Dominguez
- Department of Otorhinolaryngology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - O Aleman
- Department of Otolaryngology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J Benitez
- Department of Otolaryngology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
| | - P Perez
- Department of Otorhinolaryngology, Hospital Universitario de Cabueñes, Gijon, Spain
| | - J A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (GENYO), Granada, Spain.,Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universidad de Granada (CHUGRA), Granada, Spain
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Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
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Affiliation(s)
- J M Espinosa-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - J A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Complejo Hospitalario Universitario de Granada, Granada, Spain.
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