(514) Trends in Procedural Management of Ménière’s Disease

Introduction: In recent years, many within the otolaryngology community have discussed the implications of re-framing Ménière's Disease (MD) as a migraine-variant disorder. Little is known regarding how such shifts in perspective have affected the national landscape of MD management, particularly with regard to procedural management as more non-destructive migraine therapies are presumably being implemented. In this study, we utilized a billing database to investigate patterns in procedural management of MD to provide context about the reframing of MD as a migraine-variant disorder on otolaryngologists’ practice patterns.

Methods: Medical claims between January 2003 and December 2021 from the MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases were queried for MD ICD codes. A subset of claims were isolated via a query for CPT codes corresponding to procedures used for MD management. Descriptive statistics were performed to summarize total record counts and records per person per year.

Results: 1.75 million total claims with MD diagnostic codes were identified (MD claims). The number of MD claims peaked in 2012 with a 65% decrease in the number of MD claims from 2013 to 2021. A total of 44831 MD claims contained procedural CPT codes of interest (procedural MD claims). The number of procedural MD claims peaked in 2012 with a 50% decrease from 2013 to 2021, with the most commonly utilized procedures for MD management being intratympanic injections and endolymphatic sac surgery. From 2003 to 2021, the proportion of MD claims with procedural CPT codes increased from 1.4% in 2003 to 3.9% in 2021.

Conclusions: While the total number of procedures being used to manage MD has decreased over the last decade, the proportion of MD patients being managed with procedural therapy, most commonly intratympanic injections, has nearly tripled from 2003 to 2021. The use of endolymphatic sac surgery has decreased over the last decade. Further study is warranted to investigate factors contributing to the observed billing trends in MD management patterns, including the use of migraine-related therapies for MD management.