Meniere disease subtyping: the direction of diagnosis and treatment in the future

ABSTRACT

Introduction

Meniere’s disease (MD) is a chronic disorder of inner ear, characterized by audial and vestibular symptoms. It presents a great variability among patients in terms of clinical features, etiology, pathology, and response to the same therapy. It’s challenging to diagnose and manage for its heterogeneity. Indeed, the consensus is reached that MD has subtypes. Identifying subtypes of MD is important for individualized therapy and further research.

Areas covered

In this review, we examined the heterogeneity of MD. We also included the valid subtyping solutions and updated data regarding the association among subtypes, disease progression, and management.

Expert opinion

MD is an etiologically multifactorial condition, and it might be a constellation of symptoms associated with endolymph hydrops, not a disease entity. So far, MD can be classified as distinct phenotypes and endotype, respectively based on symptoms, pathology, possible etiology, and co-existing condition. Patients in different subtypes present different clinical features and are suitable for different treatment. The identification of these subtypes will benefit both basic and clinical studies of MD, by helping achieve personalized therapy, accurate prognosis prediction and even disease screening in near future. Therefore, MD subtyping is the emerging direction of diagnosis and treatment in the future.

KEYWORDS:

• Meniere’s disease
• phenotype
• endotype
• endolymphatic hydrops
• personalized treatment

Article highlights

• Meniere’s disease is an inner ear disease of unknown etiology with multiple contributing factors, including genetic factor, viral infection, allergy and autoimmunity.

• The therapies for MD are various, whereas, their efficacies are controversial. Most RCTs regarding MD were not able to confirm that diuretics, betahistine, intratympanic steroids were, in any way, effective or limited.

• There is enough evidence to support a subtype of patients with MD.

• So far, patient subtypes in MD can be divided into the clinical features-based method, and etiology-based ‘bottom-up’ method.

• MD subtyping is the emerging direction of diagnosis and treatment in the future.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported by a grant from the National Natural Science Foundation of China (No. 81873701) and the National Natural Science Foundation of China (No.82171152).