How to Read Epidemology Figures for Incidence

Epidemiology of Menieres Disease

Timothy C. Hain, Md • Folio concluding modified: March 13, 2021

We point the reader to a dainty review of Meniere'south published in 2002 as a expert start on this subject area (da Costa et al, 2002)

State	Prevalence/100,000	Incidence	Mystery number	Reference	Criteria/Comments
USA	218	15.3		Wladislavosky-Waserman et al, 1984	Older, loose criteria
USA	190			Harris and Alexander, 2010	Based on 60 meg patients
England			180	Cawthorne and Hewlett (1954)	Not sure if incidence or prevalence
England			100	Harrison and Naftalin, 1968)	"clinical estimate"
England	56			Goodman (1957)
Ireland		ten-xx		Wilmot (1983)	Erstwhile, loose criteria
Japan	21-36			Shojaku and Watanabe (1997) , Shojaku et al, 2009	Japanese criteria non U.s. Criteria
Sweden (Uppsala)			45	Stahle(1973)	Not certain if incidence or prevalence
Finland	43	4.3		Kotimaki et al, (1999)
Finland	513			Havia et al (2005)	Helsinki
Italy	205	8		Celestino and Ralli (1991)

There is very substantial disagreement in the world literature about the incidence (new cases/yr) and prevalence (all cases in population) of Menieres disease. This is probably due to the fact that Meniere's is a "committee disease", where diagnosis depends on whether patients elect to study symptoms rather than a being disease that is based on objective criteria. In other words, because the disease depends on whether patients elect to report symptoms, the numbers depend on the personality of the population being studied. There is too the trouble that the details of the symptoms required for the diagnosis of Meniere's proceed changing as new committees meet from time to fourth dimension, and different countries understandably choose committees made up of their fellow countrymen rather than adhering to any globe-wide standard. As the symptoms required go more stringent, less individuals encounter the requirements, so the incidence goes downwards. Finally, some authors (e.g.. Cawthorne and Hewlett, Stahle) reported a number of uncertain origin -- not clearly an incidence or prevalence.

To summarize, it appears that that Meniere's illness has a prevalence of approximately 200 cases/100,000 persons in the United states, or in other words, less than 0.2 % of the population has Meniere's disease. The prevalence may vary internationally, mayhap beingness lower by as much as a cistron of 10 in some populations, just it seems more than likely that the numbers vary so much due to departure in criteria and reporting. The prevalence increases with historic period, rather linearly, up to the age of threescore. Men and women are approximately equal in number.

State by state:

For England, Cawthorne and Hewlett (1954) reported 157 cases/100,000 cases based on the records of 8 full general practices in England during the year ending March 1952. It is unclear in their report whether those figures reflect incidence or prevalence, although Arenberg et al suggested that it is an incidence figure (1980). If prevalence, this figure would be quite like to a effigy reported for the US by Wadislowvsky and associates, after). If incidence, this figure would suggest a much higher prevalence (roughly .16 * 25%, or nigh 4 % of the population). We recall this is highly unlikely. While others have also suggested a prevalence rate every bit high equally 1% (e.yard. Morrison, 1995; Harrison and Naftalin, 1968), there seems to be little good show for this assertion. Goodman (1957) presented data suggesting of a prevalence of 0.056%, which is lower than the figure institute in the US by Wadislowvsky and associates.

In Finland, prevalence was reported to exist 43/100,000 and incidence was 4.3/100,000 (Kotimaki et al, 1999). This figure appears depression compared to the United States and England. On the other hand, Havia et al (2005) reported a prevalence of 513/100K. This is much higher than most.

In Italy, Celestino and Ralli reported an incidence rate of 8/100,000, and estimated that the prevalence was most 0.4% of the population. This would assume that nearly people with Meniere'south live with the illness, on boilerplate, for 50 years. Their instance distribution, not normalized for the age of the the population, peaked at 41-50.

In Sweden, Stahle et al reported the incidence for 1973 of Meniere's in Uppsala at 45/100,000 population. This study also used more stringent criteria for diagnosis than others have had, and is more often than not idea to be an underestimate. Meniere's illness, by their criteria, is most 4 times as common as Otosclerosis. Almost sixty% of their patients were women.

In Japan in that location have been several epidemiological studies. According to Watanabe (1988), Meniere's disease was rare until the 1950's. Since the finish of the second World War, there was a rapid increase in the number of patients designated as having Meniere's disease. In these studies they defined Meniere's as the combination of repeated attacks of vertigo, fluctuating cochlear symptoms with vertigo, and exclusion of other diseases (Watanabe et al, 1995). They reported average age of onset of 41-42 years of historic period, with a peak incidence at age 30-39. The prevalence was 16-17 per 100,000. This effigy appears very low. Shojaku and Watanabe (1997) found a prevalence of between 21.4 and 36.6/100,000 , which may still be a low gauge, in two districts of Japan. This was a rather pocket-sized study. In 2009, Shojaku, Watanabe et al reported nigh two/3 of newly diagnosed MD patients were females, and that 9.2% were bilateral. Age at onset peaked in the 3rd and 4th decades. Thus Nihon seems to accept roughly a 10th as much Meniere's disease equally the U.s. (come across below). Considering Japan's figures are wildly different than the Usa, inferences from Japan are unlikely to be valid for the US. The methods of ascertaining Meniere's in Japan may have missed 90% of the patients that might have been found in the US.

There accept been several studies of the Us population. In the largest study of Harris and Alexander (2010), as well reported in Alexander in Harris (2010) found about 200/100,000 was the prevalence effigy. This matches fairly well with the results of Wladislavosky and assembly, who at the Mayo Clinic reported a prevalence in 1980 in the Rochester Minnesota population of 218.ii cases/100,000. They too reported an incidence charge per unit of new cases of 15.3/100,000/year. They also reported a diagnosis charge per unit basically proportional to age upwardly to the age of sixty, with a decline thereafter. Bilaterality was found in 34% of their cohort. In the Framingham study, (Framingham, Mass, USA) ane.48 % of the population claimed to have a history of Meniere'southward disease (Moscicki et al, 1985). This large prevalence effigy probable derives from a tendency of many physicians to diagnose all cases of recurrent vertigo into the category of Meniere's disease (Slater, 1988), rather than to distribute them more than liberally into other vaguely defined disorders (such as migraine associated vertigo, or only "unknown")

Our experience at Chicago Dizziness and Hearing -- Meniere's disease is roughly equally distributed between women and men, with a height age of onset of about 60. This is age presenting to the clinic rather than age of onset as reported in well-nigh studies beneath. It is neither an incidence or prevalence.

The author's clinical exercise in Chicago Illinois, Chicago Dizziness and Hearing, has a very large experience with Meniere'due south, including more cases than many of the national studies reported above. In our exercise, Meniere's is diagnosed using the AAO criteria. Simply looking at age of persons diagnosed with Meniere's, according to gender (blue are women), produces the graph above. Of form this graph is fatigued from the clinic population, only might reasonably reverberate the age distribution of Meniere's in Chicago Illinois. It again shows increasing prevalence with age up to the age of 60. In the graph to a higher place, there are no children. There are rare reports of Meniere's in young children (east.g. Brantberg et al, 2012).

Gender and race:

It is by and large felt that both sexes are as affected. Nevertheless, gender ratios vary very widely. Stahle (1976) noted that the number of males exceed females (206:150) in this group. In that location may be a divergence in the distribution of severely disabled patients

Little data is available regarding racial predisposition to Meniere's affliction, aside from the nationally based studies as noted above. In 1972 Nsamba reported that Meniere'due south disease was uncommon in Uganda. Caparaosa (1963) reported that Meniere's illness was predominantly a disease of the white race and occurred only rarely in the blackness. On the other manus, Kitahara and Futaki (1974) found that the incidence of Meniere's affliction was approximately the aforementioned between American whites and American Blacks. Meniere's disease is rare in the southwestern American Indian (Wiet, 1979). To summarize, at present it is not articulate whether there are racial predispositions to Meniere's disease.

Bilaterality

The reported prevalence of bilaterality depends on how one defines bilaterality -- as a minor change in hearing in 1 ear or as having significant impact to either hearing or balance sensation. Estimates vary from as high as 34% (Wladislavosky and associates) in the United states, to equally low equally 5%. We remember that the "significant touch on" figure is likely most 5%. This number is important equally patients with unilateral Meniere'due south may fearfulness to undergo subversive treatment because of the possibility of conversion to bilateral status.

Variants

The Lermoyez variant of Meniere's is wildly uncommon. In this variant, hearing improves with a vertigo attack. Lermoyez is so uncommon equally to be virtually nonexistent.

REFERENCES

• Alexander, T. H. and J. P. Harris (2010). "Current epidemiology of Meniere's syndrome." Otolaryngol Clin Due north Am 43(5): 965-970.
• Arenberg IK, Balkany TJ, Goldman Thou, Pillsbury RC 3rd. The incidence and prevalence of Meniere's affliction -- a statistical assay of limits. Otolaryngol Clin NA 13:5:697-601, 1980
• Brantberg, K., Duan, Yard., & Falahat, B. (2012). Meniere's disease in children aged 4-7 years. Acta Otolaryngol, 132(5), 505-509. doi: 10.3109/00016489.2011.643240
• Caparosa RJ. Medical treatment of Meniere's disease, Laryngoscope 73, 66-72, 1963
• Cawthorne T, Hewlett A. Meniere'due south Illness. Proc R. Soc Med, 47:663-670, 1954
• Celistino D, Ralli G. Incidence of Meniere's illness in Italy. Am J Otology 12(2); 135-eight, 1991
• Costa SS, De Sousa LCA, Piza MRT. Meniere'due south disease: overview, epidemiology and natural history. Otolaryngol Clin NA 35 (2002) 455-495
• Goodman WS. Audible vertigo: its diagnosis and treatment -- A survey of 268 cases. J. Larng and Otol, 71, 339-55, 1957
• Harris, J. P. and T. H. Alexander (2010). "Current-day prevalence of Meniere's syndrome." Audiol Neurootol xv(5): 318-322.
• Harrison MS, Naftalin L. Meniere's disease. Mechanism and management. Springfield IL:CC Thomas, 1968
• Havia, M., et al. (2005). "Prevalence of Meniere's disease in full general population of Southern Finland." Otolaryngol Head Neck Surg 133(5): 762-768.
• Kitahara M, Futaki T. indigenous aspects of Meniere'south disease. Equilib Res Suppl 1. 1971
• Kotimaki J, Sorri M, Aantaa E, Nuutinen J. Prevalence of Meniere disease in finland. Laryngoscope 109:748-753, 1999
• Morrison AW. Apprehension in Menieres disease. J. Laryngology and Otology, 109(6): 499-502, 1995
• Mosicki EK, Elkins EF, Baum HM, McNamara PM. Hearing loss in the elderly: an epidemiologic study of the Framingham Heart Study Cohort. Ear and Hearing 6(4):184-90, 1985
• Nsamba C (1972) A comparative written report of the aetiology of vertigo in the African. J Laryng and Otol 86, 17-25
• Shojaku H, Watanabe Y.The prevalence of definate cases of Meniere's affliction ... Acta Oto-laryngologica 528:94-half-dozen, 1997
• Shojaku, H., et al. (2009). "Changes in the characteristics of definite Meniere'southward disease over time in Japan: a long-term survey by the Peripheral Vestibular Disorder Research Committee of Japan, formerly the Meniere'due south Illness Research Committee of Japan." Acta Otolaryngol 129(2): 155-160.
• Slater. Vertigo. How serious are recurrent and single attacks ? Postgraduate medicine, 54, #five, 58-67, 1988
• Stahle J. Advanced Meniere'southward illness. Acta Otol 81: 113-119, 1976
• Stahle J, Stahle C, Arenberg IK. Incidence of Menieres disease. Arch Otol 104(2):99-102, 1978
• Watanabe I. Incidence of Meniere's affliction including some other epidemiological data. In: Meniere's Disease: A comprehensive Appraisal. Edited by Westward. J. Oosterveld, 1983 (Wiley).
• Watanabe Y, Mizokoshi G, Shojaku H, Watanabi I, Hinoki One thousand, Kitahara M. Epidemiological and clinical characteristics of Menieres disease in Japan. Acta Otol (Supp) 519:206-x, 1995
• Wiet RJ. Patterns of ear disease in the southward-western American Indian. Arch Otolaryng, 105, 381-5, 1979
• Wilmot, T. J. (1983). "Meniere's illness." J Laryngol Otol Suppl eight: 85-86.
• Wladislavosky-Waserman P, Facer Grand, et al. Meniere'southward disease: a 30-twelvemonth epidemiologic and clinical study in Rochester, MN, 1951-1980. Laryngoscope 94:1098-1102, 1984

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