xRead - Episodic Vertigo (January 2026)

10976817, 2020, S2, Downloaded from https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599820909438 by Mayo Clinic Libraries, Wiley Online Library on [19/09/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

S38

Otolaryngology–Head and Neck Surgery 162(2S)

MD. 328 Furthermore, this guideline recommended stopping VR for patients with acute vertigo and fluctuating vestibular function from active MD based on level 5 evidence. 328 Despite this recommendation and the lack of clear evidence of effectiveness, VR has been used as a treatment option for non-MD disorders with fluctuating vestibular function, such as VM. 370 A Cochrane review of VR research found no studies spe cifically addressing the use of VR in the treatment of acute vertigo; however, the review found no evidence of harm for any patient receiving VR for unilateral peripheral vestibular dysfunction. 329 An SR and clinical evidence assessment from 2007 reported that VR is optional in the management of acute vertiginous attacks of MD patients. 95 The 2007 review found no RCTs regarding benefits or harms for VR in this setting. An update to this clinical evidence assess ment in 2015 proposed VR as optional for treatment of acute vertigo MD attacks. 209 The 2015 review also found no evidence of reduction of frequency or severity of acute ver tigo attacks from the literature but also identified no harms from VR. Their recommendation for optional VR was based on nonblinded research from an RCT that utilized virtual reality VR and reported lower subjective dizziness symp toms on the DHI among active MD patients receiving ther apy. 361 Overall, there is a lack of evidence to support the use of VR to mitigate the severity or frequency of acute ver tigo episodes in patients with MD. The limited evidence of the potential benefit for subjective improvement in patients with active MD must be weighed against the potential harms of the costs incurred and time invested in VR. STATEMENT 15. COUNSELING FOR AMPLIFICA TION AND HEARING ASSISTIVE TECHNOLOGY: Clinicians should counsel patients, or refer to a clinician who can counsel patients, with Me´nie`re’s disease and hearing loss on the use of amplification and hearing assistive technology. Recommendation based on cohort studies of hearing outcomes in MD and benefits of amplifi cation and cochlear implants with a preponderance of bene fit over harms. Quality improvement opportunity: Shared decision making opportunities between patients and clini cians regarding MD and hearing loss and the use of amplification and other hearing assistive technolo gies. National Quality Strategy domains: Effective Communication and Care Coordination, Person and Family Centered Care Aggregate evidence quality: Grade C, based on cohort studies of hearing outcomes in MD and ben efits of amplification and cochlear implants Level of confidence in evidence: High Benefits: Improved function, improved QOL, improved hearing, less missed work Action Statement Profile: 15

Risk, harm, cost: Clinicians and patients’ time, cre ation of unrealistic expectations Benefit-harm assessment: Preponderance of benefit over harms Value judgments: The handicap of associated hear ing loss is underrecognized in MD patients Intentional vagueness: None Role of patient preferences: Small regarding coun seling, large in terms of choice to use these technologies Exclusions: None Supporting Text The purpose of this statement is to inform clinicians about the benefits of amplification and other hearing assistive technologies and to encourage shared decision making between MD patients and clinicians about hearing loss and the use of these technologies. SNHL is one of the key criteria for the diagnosis of MD. 6 SNHL, even mild 371 and unilateral, 372 is associated with considerable functional, cognitive, social, economic, and health consequences. 373 No medical or surgical inter vention has yet been shown to effectively prevent or correct SNHL associated with MD. While there is ample literature supporting the use of hearing aids and other hearing tech nologies for SNHL, relatively little has focused on rehabili tation of SNHL due to MD. 374-378 The nature of the SNHL dictates the approach to aural rehabilitation. SNHL in MD presents unique challenges, and these change over time. 43 In early stages of MD, SNHL commonly fluctuates in the affected ear and may be only intermittent. Fitting hearing aids in mild, fluctuating SNHL is difficult, as an initially successful fitting may be followed by complaints that the sound is too soft, too loud, or dis torted soon thereafter. 376 Furthermore, overamplification could induce permanent SNHL due to excessive exposure to high-level acoustic stimuli. 379 Later in the clinical course, fluctuation tends to wane and progress to nonusable hearing in the affected ear. Additional problems with fitting hearing aids include poor speech discrimination—most commonly measured as a WRS—and the limited tolerance for amplifi cation because of the narrow dynamic range, which is the decibel difference between the threshold for an acoustic sti mulus and the level at which that sound becomes uncomfor table. As these considerations can have a substantial impact on success with various rehabilitative solutions, it is impera tive that clinicians explain them to MD patients and their families to set appropriate short- and long-term expectations. Conventional hearing aids involve a microphone, an amplifier, and a speaker that increases sound volume to the affected ear. 380 These are typically custom fit to an indi vidual’s SNHL based on audiometric testing. Modern hear ing aid technology also includes hardware (eg, multiple Policy level: Recommendation Differences of opinion: None