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

Basura et al

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microphones) and software (ie, digital noise reduction) that allow precise control for a patient’s dynamic range and opti mal hearing in a variety of listening environments. Modern digital hearing aids often require programming or manual adjustment by a hearing aid professional as SNHL fluctuates or progresses. Newer technology may allow patients to self test their hearing and adjust hearing aid output accord ingly. 376 While hearing aids can yield marked functional improvements, they are expensive and typically not covered by health insurance, including Medicare. Personal sound amplification involve a microphone, amplifier, and a speaker. They may also allow for tuning the sound output to preferentially enhance the frequencies most affected by SNHL, much as a hearing aid is fitted to an individual’s HL. These devices are typically much less expensive than conventional hearing aids; however, they lack a hearing aid’s sophisticated components that may address, for example, the narrow dynamic range and distor tion that many MD patients experience. Thus, they would be of most value for patients with mild or intermittent SNHL or as an initial sound amplification device. When SNHL progresses to severely compromised WRS or the dynamic range is too narrow, a conventional hearing aid may make hearing worse. The next step in rehabilitation might involve a CROS hearing aid. These devices include a microphone worn on the affected ear and send the sound to an amplifier/speaker on the better-hearing ear. If both ears have SNHL, microphones are placed on both ears (BiCROS). These devices facilitate the detection of sound coming from the severely impaired side. In contrast to con ventional hearing aids, which aim for optimal hearing in both ears, CROS solutions do not produce significant improvement in either sound localization or understanding speech in the presence of background noise. Some patients with severe to profound SNHL in the affected ear and normal hearing ( \ 20 dB HL PTA) in the better-hearing ear will express frustration with wearing any hearing device on the better-hearing ear. In such cases, patients may derive benefit from bone-anchored hearing devices. Bone-anchored devices provide sound awareness on the severely impaired side but have the same limitations with sound localization and speech reception in noise. In contrast to hearing aids, such implants are often covered by insurance. If SNHL is so severe that amplification provides limited benefit, cochlear implants may be employed. At present, these devices involve an external sound processor and an internally implanted receiver-stimulator. 381 The sound pro cessor converts sound to an electrical signal that is passed across the skin to the receiver-stimulator, which in turn sends a signal to a series of electrodes implanted within the cochlea. Cochlear implants can restore a substantial level of hearing to profoundly hearing-impaired MD patients, 382,383 even those who have undergone inner ear ablative labyr inthectomy. 384 These devices have also been used effec tively for MD with single-sided deafness, 385 but many

insurance companies will cover their use for only bilateral profound SNHL.

STATEMENT 16. PATIENT OUTCOMES: Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Me´nie`re’s disease after treatment. Recommendation based on the controlled arms of RCTs, outcomes from RCTs, cohort studies, and observa tional studies with a preponderance of benefit over harm. Quality improvement opportunity: Tracking out comes of therapy provides an opportunity for modi fication of management to optimize outcomes. To ensure that patients have follow-up until symptoms are under adequate control. National Quality Strategy domain: Effective Communication and Care Coordination Aggregate evidence quality: Grade C, based on the controlled arms of RCTs, outcomes from RCTs, cohort studies, and observational studies Level of confidence in evidence: Medium due to Grade C evidence Benefits: Opportunity to adjust for more effective therapy, possibility of more accurate diagnosis, opportunity for hearing rehabilitation, patient engagement Risk, harm, cost: Cost and time of visits Benefit-harm assessment: Preponderance of benefit over harms Value judgments: Not applicable Intentional vagueness: The word symptoms can refer to vertigo, hearing loss, tinnitus, or pressure depending on what is of most concern to the patient Role of patient preferences: Medium. Some patients with subjectively adequate disease control may choose not to follow up Exclusions: None Policy level: Recommendation Differences of opinion: Several group members wanted to document symptoms before, during, and after treatment, and others wanted to specifically document change in symptoms. Supporting Text The purpose of this statement is to focus on the importance of follow-up in patients with MD, to evaluate for other dis ease etiologies, to identify patients who would benefit from increased or decreased intensity of therapy, and to reduce the use of ineffective therapy. Baseline assessment should be obtained of all the possi ble clinical symptoms to evaluate effectiveness of therapeu tic options undertaken. MD has a variable clinical presentation Action Statement Profile: 16