Epidemiology of Menieres Disease
Timothy C. Hain, MD • Page last modified: March 13, 2021
We point the reader to a nice review of Meniere's published in 2002 as a good start on this subject (da Costa et al, 2002)
|USA||218||15.3||Wladislavosky-Waserman et al, 1984||Older, loose criteria|
|USA||190||Harris and Alexander, 2010||Based on 60 million patients|
|England||180||Cawthorne and Hewlett (1954)||Not sure if incidence or prevalence|
|England||100||Harrison and Naftalin, 1968)||"clinical estimate"|
|Ireland||10-20||Wilmot (1983)||Old, loose criteria|
|Japan||21-36||Shojaku and Watanabe (1997) , Shojaku et al, 2009||Japanese criteria not US Criteria|
|Sweden (Uppsala)||45||Stahle(1973)||Not sure 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/year) 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 report 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 also the problem that the details of the symptoms required for the diagnosis of Meniere's keep changing as new committees meet from time to time, and different countries understandably choose committees made up of their fellow countrymen rather than adhering to any world-wide standard. As the symptoms required become more stringent, less individuals meet the requirements, so the incidence goes down. 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 disease 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, possibly being lower by as much as a factor of 10 in some populations, but it seems more likely that the numbers vary so much due to difference in criteria and reporting. The prevalence increases with age, rather linearly, up to the age of 60. Men and women are approximately equal in number.
For England, Cawthorne and Hewlett (1954) reported 157 cases/100,000 cases based on the records of 8 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 similar to a figure reported for the US by Wadislowvsky and associates, later). If incidence, this figure would suggest a much higher prevalence (roughly .16 * 25%, or about 4 % of the population). We think this is highly unlikely. While others have also suggested a prevalence rate as high as 1% (e.g. Morrison, 1995; Harrison and Naftalin, 1968), there seems to be little good evidence for this assertion. Goodman (1957) presented data suggesting of a prevalence of 0.056%, which is lower than the figure found in the US by Wadislowvsky and associates.
In Finland, prevalence was reported to be 43/100,000 and incidence was 4.3/100,000 (Kotimaki et al, 1999). This figure appears low 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 about 0.4% of the population. This would assume that most people with Meniere's live with the disease, on average, for 50 years. Their case 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 generally thought to be an underestimate. Menieres disease, by their criteria, is about 4 times as common as Otosclerosis. About 60% of their patients were women.
In Japan there have been several epidemiological studies. According to Watanabe (1988), Meniere's disease was rare until the 1950's. Since the end 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 age, with a peak incidence at age 30-39. The prevalence was 16-17 per 100,000. This figure 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 estimate, in two districts of Japan. This was a rather small study. In 2009, Shojaku, Watanabe et al reported about 2/3 of newly diagnosed MD patients were females, and that 9.2% were bilateral. Age at onset peaked in the 3rd and 4th decades. Thus Japan seems to have roughly a 10th as much Meniere's disease as the USA (see below). Because Japan's figures are wildly different than the US, 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 have been several studies of the US population. In the largest study of Harris and Alexander (2010), also reported in Alexander in Harris (2010) found about 200/100,000 was the prevalence figure. This matches fairly well with the results of Wladislavosky and associates, who at the Mayo Clinic reported a prevalence in 1980 in the Rochester Minnesota population of 218.2 cases/100,000. They also reported an incidence rate of new cases of 15.3/100,000/year. They also reported a diagnosis rate basically proportional to age up to the age of 60, with a decline thereafter. Bilaterality was found in 34% of their cohort. In the Framingham study, (Framingham, Mass, USA) 1.48 % of the population claimed to have a history of Menieres disease (Moscicki et al, 1985). This large prevalence figure likely 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 liberally into other vaguely defined disorders (such as migraine associated vertigo, or just "unknown")
Our experience at Chicago Dizziness and Hearing -- Meniere's disease is roughly equally distributed between women and men, with a peak age of onset of about 60. This is age presenting to the clinic rather than age of onset as reported in most studies below. It is neither an incidence or prevalence.
The author's clinical practice in Chicago Illinois, Chicago Dizziness and Hearing, has a very large experience with Meniere's, including more cases than many of the national studies reported above. In our practice, 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 course this graph is drawn from the clinic population, but might reasonably reflect 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 above, there are no children. There are rare reports of Meniere's in young children (e.g. Brantberg et al, 2012).
It is generally felt that both sexes are equally affected. Nevertheless, gender ratios vary very widely. Stahle (1976) noted that the number of males exceed females (206:150) in this group. There may be a difference in the distribution of severely disabled patients
Little data is available regarding racial predisposition to Menieres disease, aside from the nationally based studies as noted above. In 1972 Nsamba reported that Meniere's disease was uncommon in Uganda. Caparaosa (1963) reported that Meniere's disease was predominantly a disease of the white race and occurred only rarely in the black. On the other hand, Kitahara and Futaki (1974) found that the incidence of Meniere's disease was approximately the same 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 clear whether there are racial predispositions to Meniere's disease.
The reported prevalence of bilaterality depends on how one defines bilaterality -- as a minor change in hearing in one ear or as having significant impact to either hearing or balance sensation. Estimates vary from as high as 34% (Wladislavosky and associates) in the US, to as low as 5%. We think that the "significant impact" figure is likely about 5%. This number is important as patients with unilateral Meniere's may fear to undergo destructive treatment because of the possibility of conversion to bilateral status.
The Lermoyez variant of Meniere's is wildly uncommon. In this variant, hearing improves with a vertigo attack. Lermoyez is so uncommon as to be almost nonexistent.