Menière's disease in the elderly.
OBJECTIVE
To assess the prevalence, presentation, treatment, and evolution of Menière's disease in elderly patients (> or = 65 yr old).


METHODS
Retrospective clinical study and case report.


METHODS
A neuro-otology referral center at the university hospital in Bern, Switzerland, and a neurotologic practice in Geneva, Switzerland.


METHODS
Patients were selected from the hospital clinic and otolaryngologic practice registers. Among 8423 neurotologic checkups performed between 1988 and 1998, 432 (5.1%) patients had definite Menière's disease and 66 (15.3%) of these patients were > or = 65 years old.


METHODS
The files of these 66 patients were analyzed.


RESULTS
Menière's disease in the elderly had 2 modes of presentation: reactivation of longstanding Menière's disease (40.9%) and de novo Menière's disease (59.1%), where the first dizzy spells, tinnitus, and hearing loss appeared after 65 years of age. Drop attacks occurred in 11.1 and 25.6% of the cases, respectively, and could be responsible for misdiagnosis of strokes of the brainstem. The patients were treated by mild antivertiginous drugs (betahistine, cinnarizine). Twenty-seven patients (41%) underwent surgery: transtympanic ventilation tubes (19 patients), sacculotomy (4 patients), vestibular neurectomy (3 patients), surgical labyrinthectomy (1 patient). The vertigo spells disappeared in 73.3 to 100% of the cases according to the type of surgery performed.


CONCLUSIONS
Our study shows that Menière's disease in the elderly is not at all uncommon. It can appear as a de novo disease or as a reactivated longstanding disease. Drop attacks are more frequent than reported in general patient populations with Menière's disease and can mimic a stroke of the brainstem. Medical and surgical treatments have to be cautious because many of these elderly patients are fragile.
Ballester
Michel
M
Department of Otorhinolaryngology, Head and Neck and Cranio-Maxillo-Facial Surgery, Inselspital University of Bern, Switzerland. ballester@caramail.com
Liard
Pierre
P
Vibert
Dominique
D
Häusler
Rudolf
R
D000368:Aged; D002150:Caloric Tests; D004584:Electronystagmography / Q000379:methods; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005260:Female; D006310:Hearing Aids; D034381:Hearing Loss / Q000453:epidemiology; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000453:epidemiology*; D012021:Reflex, Abnormal / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013198:Stapedius / Q000502:physiology