Is Early Progression to Bilateral Involvement in Menière's Disease a Poor Prognostic Indicator?

Objective:To investigate differences in the clinical features of bilateral Menière's disease (BMD) with early and late bilateral involvement.Study Design:A retrospective case-comparison study.Setting:Tertiary referral center.Patients:In total, 25 patients with definite BMD were enrolled. Patients with bilateral involvement with a transition interval shorter than 1 month were considered to have synchronous BMD, whereas the others had metachronous BMD.Interventions:We investigated differences in prognosis as defined by changes in the number of vertigo attacks after treatment, demographics, comorbidities, and inner ear function according to the transition interval from unilateral to bilateral involvement.Main Outcome Measure:We investigated other appropriate cut-off values in the interval from first- to second-ear involvement to predict poor prognosis.Results:Receiver operating characteristic curve analysis revealed that a cut-off value of<18-month interval exhibited maximum sensitivity and specificity for predicting poor prognosis. According to this value, we categorized patients into the early bilateral involvement group (EBIG, < 18 months' interval) and the late bilateral involvement group (LBIG, ≥ 18 months' interval). Patients with synchronous BMD and patients in the EBIG group exhibited poorer prognosis compared with patients with metachronous BMD and those in LBIG (p=0.011 and p ≤ 0.001). Demographics, hearing threshold, vestibular deficit, and comorbidities were not significantly different between the two groups (p>0.05). None of the patients exhibited systemic autoimmune disease.Conclusion:BMD with early bilateral progression exhibited poorer prognosis compared with late bilateral progression.