Prevalence of Menière's disease in the general population in Germany

Background: Menière's disease (MD) is characterized by vertigo attacks accompanied by cochlear symptoms and progressive low-frequency hearing loss. MD is therefore commonly suspected in patients with vertigo and cochlear disturbances. While MD accounts for about 7% of diagnoses in specialized dizziness clinics, its prevalence in the German population has not been established. Data from international studies suggest a rather low prevalence, but reported rates vary from 17 (Japan) to 218 (Rochester, USA) per 100.000. Most studies, however, have methodological limitations due to their mainly retrospective design, restriction to subpopulations not representative of the general population and variable diagnostic criteria for MD. The aim of this study was to determine the prevalence of MD in the general population in Germany.

Methods: We conducted a two-stage population-based survey on dizziness and vestibular vertigo with a representative sample of the adult population in Germany (n=4869). Moderate or severe dizziness/vertigo was reported by 1403 out of 4869 subjects. Subsequently, 1003 men and women completed a validated interview designed to differentiate between vestibular and non-vestibular vertigo. Participants who reported at least two attacks of vestibular vertigo lasting more than 20min. where questioned about accompanying cochlear symptoms and audiometric evidence of hearing loss. Diagnostic criteria for MD were based on the criteria of the AAO (1995): (1) occurrence of at least two vertigo attacks of at least 20min. duration, (2) accompanying cochlear symptoms such as tinnitus, hearing loss or aural fullness and (3) self-reported low-frequency hearing loss on audiometric testing.

Results: Out of 1003 interviewed participants, 243 had vestibular vertigo. Fifty-one out of these 243 reported at least two vertigo attacks lasting more than 20 minutes. Only one participant fulfilled the diagnostic criteria for MD, i.e. reported accompanying cochlear symptoms with vertigo attacks and a low-frequency hearing loss as documented on audiometric testing. Taking into account the two stage study design, this extrapolates to a prevalence of 29.6 (C.I. 5.2–167.7) per 100.000 in the adult population.

Conclusion: Although a frequent diagnose in specialized dizziness clinics, MD is rare at the population level when specific diagnostic criteria are applied. It can be suspected that MD is overdiagnosed in patients presenting with vertigo and cochlear symptoms.