Evolution of geriatric Meniere's disease during the past two decades.

BACKGROUND: This study compared the incidence of Meniere's disease (MD) in the elderly aged >65 years between the first (2001-2010) and second (2011-2020) decades to investigate the evolution of geriatric MD. METHODS: Totally, 1605 and 2550 patients with definite MD were experienced at the neurotological clinic during the first and the second decades, respectively. All patients were divided into three groups by 30-year age band, namely elderly (aged 65-94 years), adult (aged 35-64 years) and young (aged 5-34 years) groups, and underwent an inner ear test battery. Factors relating to the incidence of MD during the past two decades were analyzed. RESULTS: The elderly MD group comprised 198 (12.4%) of 1605 MD cases during the first decade, and 463 (18.2%) of 2550 MD cases during the second decade, showing a significantly increased incidence of elderly MD. Correlation between annual life expectancy (x) in Taiwan and annual prevalence (y) of the elderly MD in relation to total MD cases revealed y = 0.023x - 1.660 via linear regression analysis. In contrast, the adult MD group significantly differed in terms of age and gender ratio, but not incidence, between the two decades. Conversely, the young MD group exhibited significantly decreased incidence from the first decade (22.3%) to the second decade (13.8%). CONCLUSION: Evolution of geriatric MD during the past two decades reveals an increased incidence of the elderly MD patients, likely due to increased life expectancy coupled with altered life style.

Comparison of inner ear deficits in Meniere's variants and their significance.

BACKGROUND: The declining order of abnormality rates in inner ear test battery of patients with Meniere's disease (MD) is consistent with the decreasing sequence of prevalence of hydrops formation in temporal bone donors of MD. OBJECTIVE: This study investigated inner ear deficits in MD patients with falls, without falls, and after sac operation to compare their inner ear deficits. METHODS: Twenty MD patients with falls (Group A), 20 MD patients without falls (Group B), and 20 MD patients after sac operation (Group C) were enrolled. All patients underwent an inner ear test battery. RESULTS: Group A (with falls) revealed a declining sequence of abnormality rates running from audiometry (92%), cervical vestibular-evoked myogenic potential (cVEMP) test (71%), caloric test (42%) to ocular VEMP (oVEMP) test (38%). In contrast, Group B (without falls) displayed a different declining sequence of abnormality rates running from audiometry, cVEMP test, and oVEMP test to caloric test. Similarly, Group C also displayed the same declining sequence of inner ear deficits to Group A, indicating that Groups A and C may share a similar mechanism. CONCLUSIONS: Comparing the declining sequence of inner ear deficits in two inner ear disorders may help determine whether both disorders share a similar mechanism.

Evolution of vestibular disorders in older adults: From young-old to middle-old to oldest-old.

AIM: This study investigated the evolution of vestibular disorders in dizzy older adults from young-old to middle-old to oldest-old individuals, which has been less examined in detail so far. METHODS: A total of 3714 older patients with vertigo/dizziness in a university hospital were retrospectively reviewed and divided into three groups; namely, the young-old group aged 65-74 years (n = 2307), the middle-old group aged 75-84 years (n = 1176) and the oldest-old group aged ≥85 years (n = 231). All patients underwent an inner ear test battery comprising audiometry, caloric test, cervical and ocular vestibular-evoked myogenic potential tests, and foam posturography. RESULTS: The ratios between peripheral and central vestibular disorders ranged from the young-old (60:40%) and middle-old (36:64%) to the oldest-old (25:75%) groups. These results show a decreasing sequence in the prevalence of peripheral vestibular disorders (i.e. benign paroxysmal positional vertigo or Meniere's disease), and an increasing sequence in that of central vestibular disorders (i.e. vertebrobasilar artery insufficiency) from young-old to middle-old to oldest-old patients. Furthermore, the mean Romberg quotients (value from eyes closed divided by that from eyes open) of the sway area on the foam pad were 1.99 ± 0.93, 2.10 ± 1.06 and 2.62 ± 1.78 in the young-old, middle-old and oldest-old groups, respectively, showing a significant difference among them. CONCLUSIONS: Older patients with central vestibular disorders might be more prone to imbalance and falls than those with peripheral vestibular disorders, partly because patients in the latter group retain other reflex systems; that is, the visuomotor reflex to stabilize the gaze and maintain balance. Hence, adequate vision is important in maintaining balance for older adults with vertigo/dizziness. Geriatr Gerontol Int 2020; 20: 42-46.