Endolymphatic Ear disorders:

Fluctuating Tinnitus and Hearing loss without dizziness


von Dr. med. Helmut Schaaf Ltd. Oberarzt der Tinnitus Klinik Bad Arolsen
Psychotherapie
Große Allee 3, 34454 Arolsen
Email: Hschaaf@tinnitus-klinik.de


Summary

Recurrent low frequency sensory hearing loss is one characteristic sign of Meničre's disease. It is therefore often assumed to be a prodromal sign of Meničre's disease.
We report about 81 patients with recurrent low frequency sensory hearing loss who
did not previously suffered from vertigo. All patients underwent a follow-up
examination minimal 1 year until more than 10 years after onset of the disease
(average 64,65 months (SD 56,33))
Only 3,7 % of all these patients developed the typical signs of Meničres disease with
labyrinthine vertigo, but 25,9 % suffered from recurrent hearing loss and an
unspecific vertigo, which could be diagnosed and treated as psychogenic vertigo,
3.7 % showed a typical benign positional vertigo.


Deutsche Zusammenfassung:



Meničres disease is characterised by recurrent attacks of labyrinthine vertigo,
sensory hearing loss and a low frequency tinnitus (Meničre 1861). The incidence is
estimated by 1:1000 (Pfaltz and Thomsen 1986). It is well known, that Meničre's
disease could begin monosymptomatically only with recurrent low frequency sensory
hearing loss (Meyer zum Gottesberge u. Stupp 1980, Stahle et al 1991). It is
therefore often assumed, that recurrent low frequency sensory hearing loss is a
prodromal sign in the development of Meničre's disease.

Patients and methods

Between August 1995 and August 1999 we diagnosed 96 in-door-patients with
recurrent low frequency sensory hearing loss without labyrinthine vertigo. We treated
them neurootologically, including a good counseling and hearing-helps, when
necessary, and psychosomatically, aiming to reach reduce of anxiety and
depressive reactions concerning to the symptoms of recurrent hearing loss and
Tinnitus and become sufficient self competence. Before this treatment 6,2 % of the
patients were supplied with drugs like Betahistins, afterwards none continued this
kind of medication.

Between May and November 1999 we invited these 96 to an post-examination.
81 patients took part, six were moved unknown and nine refused an postexamination


The average age of the 49 women and 32 men was 51,32 years (SD = 10.55),
ranging from 29 to 72 years of age (Table 1).

Their average medical history from the onset off low frequency sensory hearing loss,
objectified by audiometrie in our hospital or before, to the time of reexaminacion
was 64,65 months (SD 56,33), ranging from minimal 12 months to 397 months.

We examined all patients neurootologically and psychologically.
The neurootological part was based on the medical history, audiometers and
vestibular tests; the psychological diagnosis on psychological interviews, including
the personal history and psy-chological tests (Personality Inventor of Freiburg (FPI),
Stress Management Questionnaire; SVF and Hamilton depressions scale).

Results :


Hearing loss:
At the time of postexamination 19 patients (23,4%) didn't have any hearing loss > 20
dB.

26 patients (32%) were showed an low frequency hearing loss from 125 Hz to 1 kHz
for one ear:
· 9 an mild hearing loss between 20 and 40 dB
· 14 showed an middle hearing loss between 40 and 60 dB
· 3 showed an severe hearing loss low frequency about 60 dB
20 patients (24,6) were affected with hearing loss from 125 Hz to 1 kHz

at both ears,
· 8 (9,8 %) with a mild hearing loss up to 20 dB at the second ear
· 9 (11,1) in both ears about up to 40 dB,
· 3 (3,7%) in both ears about 60 dB.

16 patients (19,7) showed an hearing loss at the second side independently of
fluctuation hea-ring loss, but due to noise traumata, otosklerosis and other diseases.


Vertigo:

Totally 27 patients (33,3 %) suffered from vertigo.
· 21 patients (25,9 %) suffered from an unspecific vertigo with signs of anxiety an
de-pressive reactions, which could be diagnosed and - mostly treated - as
psychogenic vertigo.

· 3 patients (3,7 %) developed after 58, 51 and 60 months the typical signs of
Meničres disease with labyrinthine vertigo.

· 3 patients (3,7 %) showed a typical benign positional vertigo, which could be
treated sufficient immediately.

Psychological co-morbidity:

We found following psychological co-morbidity (disorders):
· 48,7% depressive symptoms
· 25,6% anxiety-related disorders
· 17,9 somatoformic disorders
8% of the patients came without psychological disorders.

Discussion:

Recurrent low frequency sensory hearing loss with a low frequency, broadband
tinnitus is an frequent hearing disorder (Linßen, Schultz-Coulon 1997). Probably it is
an originally disease of its own (Lehnhardt 1984), with is caused on regulation
disorders of the cochlear endolymphs - without affection of the vestibular labyrinth.

Nevertheless it often assumed as a prodromal sign in the development of Meničre's
disease.

According to Stahle (1991) patients with Meničres disease, who showed initially only
cochlear symptoms, vertigo appears within 3 years in about two thirds of patients.

In our study only 3,7 % of all patients developed the typical signs of Meničres
disease with labyrinthine vertigo, but this first after nearly five years. That is
comparable to an earlier study of Yamasoba et al (1994). He found in five of 45
patients (11%), which where observed for more than three years, an classic
Meničres disease, which had started monosymptomatically with recurrent hearing
loss.

Our patients with Meničres disease also developed depressive symptoms with
anxiety and, as we could describe otherwise, also an reactive psychogenic dizziness
component (Schaaf, Holtmann et al. 1999, 2001).

3.7 % showed a typical benign positional vertigo, which cloud be treated by
positional ma-noeuvres.

We can thus conclude that of course every patient with Meničre's disease has to
suffer from recurrent hearing loss, but in contrary only a few patients with recurrent
hearing loss will de-velop Meničre's disease.

However many patients with low frequency sensory hearing loss develop anxiety and
psycho-genic dizziness in expectation of "imminent" Meničre's disease, what we
cloud find in 25,9 % of our patients. These usually can be treated successfully, if the
diagnosis is clear and adequate treatment, an good medical counseling and - if
necessary - psychologically psychotherapeutic aid - is applied (Schaaf 1999).

Therefore it is important to counsel these patients, that recurrent low frequency
sensory hearing loss is an mostly benign hearing disorder, which should be treated
carefully, and that the probability of developing Meničres disease is not very high. So
minimally psychogenic dizziness is mostly provided.

References:

1. Lehnhardt, E: Klinik der Innenohrschwerhörigkeiten: Tieftonschwerhörigkeit. Arch
Oto-Rhino-Larnygology. Suppl., 1-65 (1984)

2. Linßen, O., Schultz-Coulon, H.J.: Prognostische Kriterien beim Hörsturz. HNO 45.
22-29 (1997):

3. Meyer von Gottesberge, A., Stupp, H.: Meničresche Krankheit. - In: Link, R.,
Beren-des, J., Zöllner, F.: Handbuch der HNO-Heilkunde, Bd. III, Teil II. Stuttgart S.
38.22ff, (1980)

4. Paparella, MM Methods of diagnosis and treatment of Meničre's disease. In:
Huang TS (ed.) Meničre's disease. Oto-Laryngol Suppl 485, Stockholm 108-119,
(1991)

5. Pfaltz, C.R., Thomsen, J.: Symptomatology and Definition of Meničre's Disease. -
In: Pfaltz, C.R. (Ed.).: Controversial Aspects of Meničre's Disease. Stuttgart 2-4
(1986)

6. Schaaf H., Holtmann, H., Hesse, G, Rienhoff. N. Kolbe,, U., Brehmer, D.: Reactive
psychogenic dizziness in Meničre's disease. In Sterker et al (eds): Proceedings of
the 4th international Symposium on Meničre's disease 1999. Amsterdam Kugler &
Gehendi, - in preparation (winter 2000)

7. Schaaf, H.; Holtmann, H.; Hesse, G., Kolbe, U., Brehmer D.: Der (reaktive)
psychoge-ne Schwindel - eine wichtige Teilkomponente bei wiederholten M.
Meničre-Anfällen. HNO 47 10/99, 924-932 (1999)

8. Schaaf, H Die cochleäre Endolymphschwankung. Rezidivierende Hörverluste mit
tieffrequentem Tinnitus. In: Hesse, G. (Hg.) (1999) Retraining und Hörtherapie. S. 84-
87, Stuttgart, Thieme (1999):

9. Stahle, J., Friberg, U., Svedeberg, A.: Long-term Progression of Meničres
Disease. In: Huang, T.S. (Ed.): Meničre's Disease: Recent Advances in Basic and
Clinical Aspects. Acta Oto-Laryngol. Stockh. Suppl. 485, S. 78-83 (1991)

10. Yamasoba, T., Kikuchi, S., Sugaswa, M., Yagi, M., Harada, T: Acute Low-Tone
Sensoneurial hearing loss without vertigo. Ach Otololaryngol head Neck Surg/ 120,
532-535 (1994)


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15.3. 2004