| Part IThe clinical characteristics of patients with Meniere's diseaseObjectives:The study aimed to investigate the clinical characteristics of patients with Meniere's disease and compare the characteristics of patients with different clinical stages,so as to provide a reference for the diagnosis and treatment of patients with Meniere's disease.Methods:From June 2017 to December 2020,the study enrolled 232 patients with a clinical diagnosis of definite Meniere's disease at the Department of Otolaryngology Head and Neck surgery in the Second Affiliated Hospital of Nanchang University.The clinical characteristics of the patients were analyzed,such as gender,age,side of affected ear,course of disease,frequency of vertigo attack and clinical stage.The gender,side of affected ear,age and Dizziness Handicap Inventory(DHI)scores of patients with unilateral Meniere's disease in different clinical stages were statistically analyzed.Results:1.Among 232 patients with Meniere's disease,there were 94 male patients and138 female patients.The ratio of male to female was 1:1.47.The average age was56.03±12.90 years.The number and percentage of patients in different age groups were as follows:8 cases(3.4%)aged 20-29,17 cases(7.3%)aged 30-39,38 cases(16.4%)aged 40-49,72 cases(31.0%)aged 50-59,65 cases(28.0%)aged 60-69,24cases(10.3%)aged 70-79,8 cases(3.4%)aged 80-83.The high prevalence of Meniere's disease is in the age range of 40-69 years,accounting for 75.4%of all Meniere's disease patients.The affected ears were classified into 117 cases on the left side,97 cases on the right side,and 18 cases on bilateral side,accounting for 50.4%,41.8%,and 7.8%,respectively.2.The average time from the onset of Meniere's disease to the diagnosis in our department is 1.65 years,the shortest is 1 week,and the longest is 30 years.There were 35 patients with a course of 1 week to 1 month,66 patients with a course of more than 1 month to 1 year,108 patients with a course of more than 1 year to 10years,and 23 patients with a course of more than 10 years.There were 108 patients with vertigo attacks more than 12 times/year,accounting for 46.6%;124 patients with vertigo attacks less than or equal to 12 times/year,accounting for 53.4%.3.Among 232 patients with Meniere's disease,there were 18 patients with bilateral Meniere's disease,with a total of 250 ears.And there were 12 ears in stage I,52 ears in stage II,136 ears in stage III and 50 ears in stage IV,accounting for 4.8%,20.8%,54.4%and 20.0%respectively.4.214 patients with unilateral Meniere's disease were divided into four stages.There was no significant difference in gender distribution among the patients in stage I to stage IV(x~2=1.427,p=0.712).There was no significant difference in the distribution of affected ears(x~2=1.675,p=0.639).The age of patients in stage I to stage IV was significantly different(F=3.791,p=0.011).The average age of patients in stage I was significantly lower than that in stage III and stage IV(p=0.034,p=0.017).The average age of patients in stage I was lower than that in stage II,the average age of patients in stage II was lower than that in stage III and IV patients,and the average age of patients in stage III was lower than that in stage IV,but there were no statistical significance(p>0.05).5.There are significant differences in the functional,emotional,physical and total scores of the DHI scale for patients from stage I to stage IV(p<0.001).The functional,emotional,physical and total scores of the DHI scale for patients in stage I were lower than those in stage III and stage IV,which was statistically significant(p<0.05);The functional,emotional,physical and total scores of the DHI scale for patients in stage II were lower than those in stage IV,with statistical significance(p<0.05).However,there were no significant difference in the functional,emotional,physical and total scores of the DHI scale for patients between stage I and stage II,stage II and stage III,stage III and stage IV(p>0.05).Conclusions:1.Among patients with Meniere's disease,female patients were more than male patients,the age of high prevalence ranged from 40 to 69 years.Patients with the left side of the affected ear were more than those with the right side,and patients with the bilateral side of the affected ear were the least.2.The average course of patients with Meniere's disease before diagnosis was1.65 years and the patients with vertigo attacks more than 12 times/year are less than those with vertigo attacks less than or equal to 12 times/year.3.There was no significant difference in the distribution of gender and the side of the affected ear in patients with unilateral Meniere's disease from stage I to stage IV.The age of patients in stage I was lower than that in stage III and IV.4.The quality of life associated with vertigo of patients in stage I was higher than that in stage III and IV,and the quality of life associated with vertigo of patients in stage II was higher than that in stage IV.Part II The benefits of betahistine and vestibular rehabilitation therapy on the quality of life and balance function in patients with Meniere's diseaseObjectives:To evaluate the benefits of betahistine or vestibular rehabilitation therapy on the quality of life and balance function in patients with Meniere's disease.Methods:66 Meniere's disease patients with dizziness and imbalance were randomly divided into one of the following three groups(n=22 patients per group): 1)Drug group,in which patients were treated with betahistine(3×12 mg daily)for a mouth;2)Vestibular rehabilitation group,in which patients received vestibular rehabilitation therapy(Tetrax biofeedback balance training)for 30 min/day for a mouth;and 3)Control group,in which patients received no special treatment.During the one-month study period,three patients had a vertigo attack,two patients were unable to participate in vestibular rehabilitation therapy on time,and they were excluded from the study.Then,61 patients completed the programme,including 21 in the drug group,20 in the vestibular rehabilitation group,and 20 in the control group.One day before and after treatment,all patients were evaluated by the Dizziness Handicap Inventory Scale and examined with the Tetrax balance and stability test system.Results:1.There was a significantly positive correlation between total scores of the DHI scale and FI scores in Meniere's disease patients with dizziness and imbalance whether before or after treatment(r=0.824 and 0.834 respectively,p<0.001).2.Patients in drug group and vestibular rehabilitation group showed significant improvements in the functional,emotional,physical and total scores of the DHI scale after vs before treatment(p<0.05),and there were no improvements in control group(p>0.05).Additionally,The improvements of the functional,emotional,physical and total scores for patients in vestibular rehabilitation group were significantly greater than those in drug group(p<0.05),and those in drug group were significantly greater than those in control group(p<0.05).3.After treatment,the stability index of patients in drug group was significantly lower than that before treatment in the NO,NC,PO,and PC test postures(p<0.05),and The stability index had no significant change compared with that before treatment in the HR,HL,HB,and HF test postures(p>0.05).the stability index of patients in vestibular rehabilitation group was significantly lower than that before treatment in NO,NC,PO,PC,HR,HL,HB,and HF test postures(p<0.05).while the stability index of patients in control group did not change significantly in NO,NC,PO,PC,HR,HL,HB,and HF test postures compared with before treatment(p>0.05).After treatment,there was no significant difference in the improvement of stability index among the three groups in NO,NC,PO,PC,HR,HL,HB,and HF test postures(p>0.05).4.Patients in drug group and vestibular rehabilitation group showed significant improvements in the fall index after vs before treatment(p<0.001);and there were no improvements in control group(p=0.180).Additionally,there was a significant difference in the improvements of the fall index among the three groups after treatment(F=4.083,p=0.022).The improvements of the fall index for patients in vestibular rehabilitation group were significantly greater than those in drug group(p<0.001),and those in drug group were significantly greater than those in control group(p<0.001).Conclusions:1.In patients with Meniere's disease,there is a negative correlation between quality of life and fall risk.2.Betahistine and vestibular rehabilitation therapy can improve the quality of life and balance function in patients with Meniere's disease.Vestibular rehabilitation therapy is better than betahistine in improving the quality of life and balance function of patients with Meniere's disease.Part III The benefits of vestibular rehabilitation therapy on the quality of life and balance function of patients with Meniere's disease after endolymphatic sac decompression combined with semicircular canal occlusionObjectives:To investigate the benefits of endolymphatic sac decompression combined with semicircular canal occlusion on the quality of life and balance function of patients with Meniere's disease and the benefits of vestibular rehabilitation therapy on the quality of life and balance function of patients with Meniere's disease after surgeryMethods:20 patients with Meniere's disease were randomly divided into two groups: control group and vestibular rehabilitation group,with 10 patients in each group.Both groups of patients were treated with endolymphatic sac decompression and three semicircular canal occlusion.The patients were followed up for 6 months.Patients in the control group had no special treatment after surgery,while patients in the vestibular rehabilitation group received vestibular rehabilitation therapy(Tetrax biofeedback balance training)on the 3rd day after surgery,30 minutes each time,once a day for 4 weeks.The patients in the two groups were evaluated by the Dizziness Handicap Inventory Scale and examined with the Tetrax balance and stability test system on the day before surgery,the third day after surgery,one month after surgery,and six months after surgery,respectively.Results:1.No postoperative complications,such as facial nerve palsy,cerebrospinal fluid leakage,infection,etc.,were found in all the patients after the operation.All patients suffered from transient vertigo and balance disorder,and vertigo gradually disappeared within one week after the operation.Two months after the operation,the patient underwent magnetic resonance hydrography examination of the inner ear,which showed that the three semicircular canals on the affected side were not developed,indicating that the obstruction of the three semicircular canals were successful during the operation.During the follow-up period of half a year,none of the patients had vertigo epiodes again,and the vertigo control rate was 100%.Hearing loss was found in 7 patients and no significant change was found in 13 patients,with a hearing retention rate of 65%.2.There was no significant difference in the functional,emotional,physical and total scores of the DHI scale between the vestibular rehabilitation group and the control group before operation,on the 3rd day after operation and at 6 months after operation(p>0.05);at 1 month after operation,the scores of the DHI scale in the vestibular rehabilitation group were significantly lower than those in the control group(p<0.05).In the vestibular rehabilitation group,the DHI scale scores of the patients on the 3rd day after operation were significantly higher than those before operation(p<0.05),and the DHI scale scores of the patients at 1 month and 6 months after operation were significantly lower than those before operation(p<0.05).In the control group,on the 3rd day after operation,the DHI scale scores of patients were significantly higher than those before operation(p<0.05);at 1 month after operation,the DHI scale scores of patients had no significant difference compared with those before operation(p>0.05);at 6 months after operation,the DHI scale scores of patients were significantly lower than those before operation(p<0.05).3.In the NO,NC,PO and PC test positions,there was no significant difference in the stability index between the vestibular rehabilitation group and the control group before operation,on the 3rd day after operation and at 6 months after operation(p>0.05));at 1 month after operation,the stability index of the vestibular rehabilitation group was significantly lower than that of the control group(p<0.05).In the vestibular rehabilitation group,the stability index on the 3rd day after operation was significantly higher than that before operation(p<0.05),and the stability index at 1 month and 6 months after operation was significantly lower than that before operation(p<0.05).In the control group,the stability index on the 3rd day after operation was significantly higher than that before operation(p<0.05);at 1 month after operation,there was no significant difference in the stability index of the patients compared with that before operation(p=1.000);at 6 months after operation,the stability index of the patients was significantly lower than that before operation(p<0.05).In the HR,HL,HB and HF test positions,the interaction of group and time had no statistically significant effect on the stability index(p>0.05).The main effects of group factors on the stability index were not statistically significant(p>0.05),and the main effects of time factors on the stability index were not statistically significant(p>0.05).4.There was no significant difference in the fall index between the vestibular rehabilitation group and the control group before operation,on the 3rd day after operation and at 6 months after operation(p>0.05);at 1 month after the operation,the fall index of the vestibular rehabilitation group was significantly lower than that of the control group [F(1,9)=14.878,p=0.004].In the vestibular rehabilitation group,on the 3rd day after operation,the patient's fall index was significantly higher than that before operation(p<0.001);at 1 month and 6 months after operation,the patient's fall index was significantly lower than that before operation(p<0.05).In the control group,on the 3rd day after surgery,the patient's fall index was significantly higher than that before operation(p<0.001);at 1 month after operation,the patient's fall index was not significantly different from that before operation(p=1.000);at 6 months after operation,the patient's fall index was significantly lower than that before operation(p<0.001).Conclusions:1.Endolymphatic sac decompression combined with semicircular canal occlusion is safe and effective in the treatment of intractable Meniere's disease,with good vertigo control.2.Endolymphatic sac decompression combined with semicircular canal occlusion can temporarily reduce the quality of life and balance function of patients with Meniere's disease,but with the compensation of vestibular function,the quality of life and balance function of patients can be significantly improved.3.Vestibular rehabilitation therapy can improve the postoperative quality of life of patients undergoing surgery for Meniere's disease,promote the recovery of balance function,increase postural stability and reduce the risk of falls. |
PDF Full Text Request