Constant Dizziness Versus Episodic Vertigo in Ménière's Disease: Health-Related Quality of Life, Cognitive Dissonance, and Postural Problems.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

Electroencephalography microstate alterations reflect potential double-edged cognitive adaptation in Ménière's disease.

PURPOSE: To explore the microstate characteristics and underlying brain network activity of Ménière's disease (MD) patients based on high-density electroencephalography (EEG), elucidate the association between microstate dynamics and clinical manifestation, and explore the potential of EEG microstate features as future neurobiomarkers for MD. METHODS: Thirty-two patients diagnosed with MD and 29 healthy controls (HC) matched for demographic characteristics were included in the study. Dysfunction and subjective symptom severity were assessed by neuropsychological questionnaires, pure tone audiometry, and vestibular function tests. Resting-state EEG recordings were obtained using a 256-channel EEG system, and the electric field topographies were clustered into four dominant microstate classes (A, B, C, and D). The dynamic parameters of each microstate were analyzed and utilized as input for a support vector machine (SVM) classifier to identify significant microstate signatures associated with MD. The clinical significance was further explored through Spearman correlation analysis. RESULTS: MD patients exhibited an increased presence of microstate class C and a decreased frequency of transitions between microstate class A and B, as well as between class A and D. The transitions from microstate class A to C were also elevated. Further analysis revealed a positive correlation between equilibrium scores and the transitions from microstate class A to C under somatosensory challenging conditions. Conversely, transitions between class A and B were negatively correlated with vertigo symptoms. No significant correlations were detected between these characteristics and auditory test results or emotional scores. Utilizing the microstate features identified via sequential backward selection, the linear SVM classifier achieved a sensitivity of 86.21% and a specificity of 90.61% in distinguishing MD patients from HC. CONCLUSIONS: We identified several EEG microstate characteristics in MD patients that facilitate postural control yet exacerbate subjective symptoms, and effectively discriminate MD from HC. The microstate features may offer a new approach for optimizing cognitive compensation strategies and exploring potential neurobiological markers in MD.

Psychological Distress and Meniere's Disease: A Bidirectional Two-Sample Mendelian Randomization Study.

OBJECTIVE: This study is aim to explore the causal relationship between anxiety, depression, neuroticism, and Meniere's disease (MD). STUDY DESIGN: Two-sample bidirectional Mendelian randomization (MR) analyses. SETTING: IEU, FinnGen, CTG, and UKB databases. METHODS: The genome-wide association studies data for anxiety, depression, neuroticism, and MD involved over 357,957 participants. MR was performed to explore relationships between anxiety, depression, neuroticism, and MD. Sensitivity analyses were performed to assess the robustness of the MR results. Reverse MR was used to exclude the possibility of reverse causality. Finally, multivariate MR was performed to explore the collinear relationships between neuroticism subclusters. RESULTS: MR results showed that anxiety and depression are not causes of MD, nor does MD cause anxiety and depression. Elevated neuroticism sum score is a cause of anxiety, depression, and MD, but MD does not lead to an increase in the level of neuroticism sum score. Further analysis showed that the 5 subclusters of neuroticism often feel lonely, mood often goes up and down, often feel fed-up, feelings easily hurt, and sensitivity to environmental stress and adversity are causes of MD. Multivariate MR analysis results suggested that the 5 neuroticism subclusters have a collinear relationship. CONCLUSION: Anxiety and depression are not causative factors of MD, and vice versa. Elevated neuroticism levels serve as a shared causative factor for anxiety, depression, and MD. Identification and effective management of neuroticism is a potential target for preventing and treating MD.

[Qualitative Study on the Experience of Patients with Meniere Disease].

PURPOSE: The purpose of this study was to understand and describe the experiences of patients with Meniere disease. METHODS: Data were collected from February 19, 2019, to February 5, 2020, through individual in-depth interviews with 13 Meniere patients. Verbatim transcripts were analyzed using Colaizzi's phenomenological analysis. RESULTS: The experiences of patients with Meniere disease were clustered into the following four themes from 22 meaning units: 1) Complex unfamiliar symptoms that shatter both balance of the body and peace of the heart; 2) A disease that health professionals and medical treatment cannot cure; 3) Suffering hardships that cannot be understood by non-Meniere's sufferers; and 4) Making daily efforts to become healthier. Meniere's symptoms are life-shattering and depressing because they are neither visible nor easily curable. Over time, as they accepted the reality of living with the disease, the participants would shift their focus from complete symptomatic cure to leading a healthy and more balanced life. CONCLUSION: This study shows that Meniere disease has a pervasive impact on all aspects of the patients' lives. Patients are prone to experiencing restrictions in their social functioning and activities. They also experience psychosocial problems due to the unseen nature of their symptoms. This study elucidates the experiences of Meniere patients and the need for nursing intervention to help improve their quality of life and ability to self-manage. Lastly, this study shows the need for a coordinated interdisciplinary approach to raising public awareness of the disease.

Persistence of Non-Vertigo Symptoms in Meniere Disease During Remission - A Preliminary Report.

BACKGROUND: Though the absence of vertigo in Meniere disease is often interpreted as remission, patient-centered subjective assessment of quality of life remains the best indicator of such remission. STUDY OBJECTIVE: To assess the presence and severity of aural pressure/tinnitus, hearing loss, unsteadiness, nausea and vomiting in MD patients during remission. SETTING: Urban tertiary care referral hospital in a developing country. METHODOLOGY: Consecutive patients with diagnosis of Definite Meniere were selected from the Balance and Dizziness Clinic of National Hospital Abuja for the study. Quality of life assessment was carried out using 3 validated tools - Modified MD-POSI, Vertigo Symptom Scale and Tinnitus Handicap Inventory (THI). Patients were included only when they have been vertigo free for at least 4 weeks. Pure tone audiometry was carried out in those with subjective hearing loss at recruitment and 4 weeks later. RESULTS: A total of 26 patients completed the study. All had cinnarizine for acute vertigo control and Betahistine for maintenance of vertigo control. There was female preponderance (17:9). The age range was 32-56 years. The duration of MD ranges from 4 months to 12 years. The total and subscale MD-POSI scores for "between attacks" significantly correlated with hearing, unsteadiness and tinnitus/pressure when compared to during attack. 69.2 per cent of participants experienced symptoms of unsteadiness during remission. 13/26 of participants reported persistent, though less annoying tinnitus that poorly correlated with THI score during remission. CONCLUSION: Our study showed that significant non-vertigo symptoms affect the quality of life during remission. Perhaps there is need to properly define, in future studies, what constitutes remission in patients with MD.

The Use of the Internet and Social Media by Individuals with Ménière's Disease: An Exploratory Survey of Finnish Ménière Federation Members.

OBJECTIVES: The present study explored the use of the Internet and social media by individuals with Ménière's disease (MD). MATERIALS AND METHODS: This study utilized a retrospective design and included the data of 465 individuals with MD from the Finnish Ménière Federation (FMF) database. Moreover, the participants included 346 females (i.e., approximately 75% of the sample), with roughly 95% of which middle-aged or older adults. An Internet-based survey was used to collect the demographic information and determine the use of the Internet and social media by individuals with MD in order to establish a computer-based peer support program. RESULTS: Based on the findings, more than 90% of the respondents reported using the Internet, 70% used the Internet to gather information about MD, and 47% stated that they trusted the information on the Internet. CONCLUSION: The Internet and social media are frequently used by individuals with MD to gather information about their health conditions. Therefore, it is essential to ensure that appropriate and accurate information is available via Internet websites and social media platforms.

Depression in Ménière's disease: a systematic review and meta-analysis.

BACKGROUND: Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression. METHODS: Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study. RESULTS: Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21-88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9-63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire - Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively. CONCLUSION: The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.

[Effect of the stapedius and tensor tympani muscles tenotomy on the quality of life of patients suffering from Ménière's disease]. / A musculus tensor tympani és a musculus stapedius ín átvágásának hatása a Ménière-betegségben szenvedok életminoségére.

Introduction: Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. Aim: The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). Method: A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. Statistical analysis: The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. Results: A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Conclusion: Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.

Alcohol consumption in Menière's disease patients.

Objectives: Dietary changes are useful in the management of Menière's disease; regarding alcohol, many clinicians recommend to avoid or reduce its consumption. However, there are no researches aimed to evaluate whether habitual alcohol consumption is more prevalent and/or more intense in patients with Menière's disease.Methods: Cross-sectional, observational, case-control study, including three groups: patients with Menière's disease, patients with vertigo of other origins, and control subjects. Alcohol consumption was compared between these three groups. Participants in this study were grouped according to alcohol consumption as follows: categorization A1 (nonalcohol vs. alcohol consumers), categorization A2 (nonalcohol, low, moderate, and high alcohol consumers), and categorization A3 (light alcohol consumers: nonconsumers plus low consumers; heavy alcohol consumers: moderate plus high consumers).Results: A total of 180 subjects were included in this study (72 in group A, 72 in group B, and 36 in control group); 117 were women. The mean age was 52.7 years. Mean alcohol consumption was 41.22 g/week. Average consumption of alcohol in group A (50.42 g/week) was higher than in other two groups (36.53 g/week in B and 32.22 g/week in C), but differences were not statistically significant. In Menière's group, light alcohol consumers showed age at onset of symptoms (49.39 years) lower than heavy alcohol consumers (55.51 years). No relationship was observed between alcohol consumption and uni or bilateral affectation.Discussion: It is possible that alcohol consumption delays the age at onset of Menière's disease. A hypothetical explanation is the inhibitory effect of alcohol on hypothalamic production of vasopressin. A reduced release of this neurohormone would increase diuresis and decrease endolymphatic pressure.

Living with Ménière's disease: an interpretative phenomenological analysis.

Purpose: To explore the meanings of Ménière's disease from the perspective of people living with this condition and to understand what was considered significant and important in participants' everyday lives.Materials and methods: Four women with Ménière's disease participated in face-to-face semi-structured interviews. Accounts were recorded, transcribed, and analysed using an iterative process integral to Interpretative Phenomenological Analysis.Results: Three interconnected themes were identified. "You have no control whatsoever" conveys participants' perceptions of vertigo as having a disruptive and ongoing impact on physical and psychosocial function in everyday life. "Ménière's takes away your life completely" describes Ménière's as impinging on participants' most meaningful activities and relationships, and as restricting their ability to live their lives on their own terms. "You get on with life" recounts participants' efforts to refashion their lives whilst living with this condition and manage its most harmful effects. The psychosocial impact of living with Ménière's disease and its relevance to rehabilitation is discussed.Conclusions: Ménière's disease has an enduring physical and psychosocial impact. Clinicians who acknowledge and respond to an individual's subjective experience of their condition may be key to their engagement in therapy. Service users should have a voice in health service design and delivery.Implications for rehabilitationMénière's disease is a long-term disabling condition that not only impacts on physical and psychosocial functioning but also restricts quality of life through stigmatisation.Fear of triggering an attack of vertigo may prevent people with Ménière's disease from engaging with rehabilitation.Therapists who adopt a biopsychosocial approach and who recognise patients' efforts to control their symptoms as a positive form of resistance may be better equipped to empathetically support patients to engage in new activities that may be vital to improving their lives.

Driving Habits and Risk of Traffic Accidents among People with Ménière's Disease in Finland.

OBJECTIVES: The study evaluated the driving habits and risk of traffic accidents among people with Ménière's disease (MD) in Finland. MATERIALS AND METHODS: The study used a cross-sectional survey design. Members of the Finnish Ménière Federation (FMF) were contacted and requested to participate in an online survey. In total, 558 FMF members (58.7% response rate) responded to the survey. RESULTS: People with MD were responsible for significantly fewer traffic accidents (0.8%) annually than individuals in the general population (1.7%). In addition, the lifetime risk of car accidents was lower among subjects with MD (8.3%) than that among individuals in the general population (24 to 28%). Nearly half of the total participants had either reduced the frequency of driving or had given up driving because of their condition. Factors such as gender, balance problems, visual problems with visual aura, and syncope during vestibular drop attacks can help explain the reasons for giving up car driving. One third (35.9%) of the participants were able to anticipate the MD attack before they decided to drive a car. Participants with falls during a vestibular drop attack, attacks of rotary vertigo, syncope during vestibular drop attacks, and those who were of a younger age were at a higher risk of experiencing a vertigo attack while driving a car. The most common strategies to avoid car accidents were selective driving and not driving when symptoms appeared. CONCLUSION: The results show that people with MD are at a lower risk of traffic accidents than individuals in the general population, which can be explained by selective driving.

Patient Perceptions of Effectiveness in Treatments for Menière's Disease: a National Survey in Italy.

OBJECTIVES: The aim of the present study was to investigate current treatment practices and self-reported effectiveness in Ménière's disease. MATERIALS AND METHODS: Members of two Italian Ménière's disease support (n=170) with ≥6-month history of Ménière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life, work, or travel as included in the Social Life and Work Impact of Dizziness Questionnaire before and after recent treatments were queried. RESULTS: Twenty-four different treatments were reported for Ménière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being the most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments, 78%-89% of respondents indicated limitations in family or social life, work, or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6±4.6, p<0.001), days off work per month (10.1±9.2 vs. 4.2±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (p<0.05 for all). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (p<0.01 for all), as well as the fewest respondents reporting post-treatment functional limitations (16%-37%). CONCLUSION: Despite many treatment approaches targeting different proposed pathophysiology for Ménière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Ménière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Ménière's disease.

[Possible effect of diabetes and hypertension on the quality of life of patients suffering from Ménière's disease]. / A diabetes mellitus és a hypertonia lehetséges hatása a Ménière-betegségben szenvedok életminoségére.

INTRODUCTION: Ménière's disease is a disorder of the inner ear, characterized by episodic rotational vertigo, sensorineural hearing loss, tinnitus, aural pressure and vegetative symptoms. Since the improvement of these symptoms exerts an influence on the patients' quality of life and the condition seems to be incurable, the symptomatic treatment suggests an important question. AIM: Our study's aim is to evaluate how hypertension and diabetes exert influence on the patients' quality of life and how effective conservative pharmacologic treatment is. According to our assumption, both comorbidities have a significant influence on the symptoms and the therapy. MATERIAL AND METHOD: Complete hospital documentation of 105 (31 men and 74 women, mean ± SD age, 57.4 ± 11.05) patients with definite Ménière's disease was analysed. The performance of the statistical analysis was completed by using IBM's SPSS V24 software. RESULTS: The appearance of comorbid patients was more frequent than that of not comorbid patients. The influence of hypertension was supported by the tendency of the vertigo attacks, the higher doses of betahistine, and the larger need for the course of infusions. In the case of hearing loss, the negative effects of diabetes were confirmed by the more frequent appearance of the higher stages of hearing loss and the incidence of the hearing loss' damage, whereas in the relationship between the hearing loss and hypertension by the negative reply to the conservative therapy. CONCLUSION: The comorbidities have considerable effect on the condition of MD patients, so internal medical control is essential because of the control of the quality of life. Orv Hetil. 2019; 160(4): 144-150.

Evaluating Quality of Life in Patients With Meniere's Disease Treated as Migraine.

OBJECTIVE:: To evaluate the change in quality of life (QOL) of patients with Meniere's disease (MD) after treatment with migraine prophylaxis therapy. METHODS:: Patients with definite MD were given the Meniere's Disease Outcomes Questionnaire-Retrospective (MDOQ-R) after migraine prophylactic therapy to assess QOL. Changes in physical, emotional, and social parameters affected by MD were calculated, along with a global pre- and posttreatment QOL scores. RESULTS:: The MDOQ-R was given to 27 consecutive patients with definite MD. Patients who had at least an 18-month follow-up were included, resulting in 25 questionnaires. The mean change in QOL score was 25 ± 16 (range, -3 to 55), P = .02. Quality of life was improved in 23 (92%) of the respondents in every metric measured, unchanged in 1 (4%), and poorer in 1 (4%) of patients after migraine prophylaxis treatment. CONCLUSIONS:: Majority of MD patients who had all failed diuretic therapy responded positively to medications used for migraine prophylaxis, as indicated by a significant improvement in QOL. This study may further suggest a correlation between the pathophysiologic basis of disease in MD and vestibular migraine. Patients with MD may be successfully managed with medications intended to treat migraine.

[Postoperative anxiety and its relationship with life quality in patients with Ménière's diseases].

OBJECTIVE: To investigate the postoperative anxiety and its relationship with life quality in patients with Ménière's diseases.
 Methods: A total of 68 patients with Ménière's disease, who received the treatment of endolymphatic sac decompression from 2010 to 2016, were enrolled. They finished two scales (the self-rating anxiety scale and the quality of life questionnaire for endolymphatic sac decompression of Ménière's disease) by snail mail. The patients were divided into different groups based on their preoperative course, postoperative follow-up time, clinic stage and quality of life after endolymphatic sac decompression surgery, and their anxiety was analyzed. In addition, 109 gender and age-matched patients with other diseases of otorhinolaryngology served as the control group, and their anxiety was also analyzed.
 Results: There was no statistical difference in the postoperative anxiety among the patients with preoperative course for less than 1 year, 1 to 5 years or more than 5 years (all P>0.05). There was no statistical difference in the patients with different duration of follow-up (P>0.05). There was no statistical difference in the patients with the different clinic stages (all P>0.05). There was no statistical difference in the patients with the improved life or non-improved life after surgery (P>0.05). The degree of the anxiety in the Ménière's group was more severe than that in the control group (P<0.01).
 Conclusion: It needs to keep in mind that a certain degree of postoperative anxiety still keeps in patients with Ménière's disease.

Impact of Ménière's Disease on Significant Others' Health and Lives.

BACKGROUND: Ménière's disease (MD) is a chronic and, in part, intermittent illness that poses multiple challenges for both the physical and psychological well-being of patients, as well as on those around them. The patients face psychosocial consequences, which include disruptions to life goals, employment, income, relationships, leisure activities, and daily living activities that also influence their family members and friends. However, there is a limited understanding of the impact of MD on significant others (SOs). PURPOSE: The current study was aimed at identifying how the SOs of patients with MD respond to different aspects of the impact of the disorder on health and life (i.e., psychological aspects, activities, participation, and positive aspects). RESEARCH DESIGN: The study employed a cross-sectional survey design. STUDY SAMPLE: The study sample was 186 SOs of patients with MD who were recruited through Finnish Ménière's Federation. DATA COLLECTION AND ANALYSIS: Participants completed a 25-item structured questionnaire focusing on different aspects of the impact of the disorder on health and life, and also provided some demographic information. Data were analyzed using Kruskal-Wallis test, Pearson's correlation, and K-means cluster analysis techniques. RESULTS: Examination of response patterns suggests that the disorder had, on average, a marginal effect on SOs' psychological aspects, activities, and participation as the SOs generally focused on complaints. Interestingly, SOs reported some positive consequences as a result of their partners' condition. The results show a limited association between SOs' demographic variables and response patterns. The Pearson's correlation suggested a strong association between the subscales psychological aspects, activity limitations, and participation restrictions. Also, a weak negative correlation was observed among positive aspects and participation restrictions. The cluster analysis resulted in three clusters, namely, (1) "nonengaged," (2) "supportive," and (3) "concerned." CONCLUSIONS: The current study results identify that the SOs' reaction to patients' condition varies and this may be from coping with victimization. Although the impact of MD on SOs is limited, some of the SOs may have more severe consequences and may require rehabilitation. The information gathered about SOs' coping and adjustment in this study can also help while developing management and/or rehabilitation plan for people with MD.

Relational quality, illness interference, and partner support in Ménière's disease.

OBJECTIVE: The current study aimed to better understand how patients and their significant others (SOs) cope with Menière's disease (MD). DESIGN: The study used a cross-sectional design and the data were collected using questionnaires. STUDY SAMPLE: Seventy-five dyads in which one person had MD. RESULTS: SOs of patients with MD not only experienced activity and participation restrictions but also had positive experiences. In relational quality, the SOs reported uncertainty of their future, limited visits in noisy places, limited activities as walking, watching TV, and participating in social life. The illness interference correlated with the patients' complaints, and most significant was the problem of imbalance. The quality of life was significantly reduced in patients with MD, and the illness interference in terms of quality of life was correlated with the SOs in items related to mood and anxiety. The stress related conditions of the SOs were correlated with two positive items (e.g. alleviating the stress factor). The SOs could also identify one positive item (i.e., improved relationship). CONCLUSIONS: Perceptions of MD as interfering in couples' lives influence dyadic coping in unique ways. The current study identified that dyadic coping has both positive aspects and limitations as a consequence of their partner's MD.

The Reliability and Validity of "Dokuz Eylül University Meniere's Disease Disability Scale".

OBJECTIVE: Ménière's Disease (MD) is a chronic, non-life threatening inner ear disease, with attacks of disabling vertigo, progressive hearing loss, and tinnitus as the major symptoms. All three symptoms, separately or in combination, cause great distress and have a considerable impact on the quality of life of the patients. The aims of this study were to develop a disease-specific quality of life survey for patients with MD and to analyze the relationships between the audiovestibular findings and the survey. MATERIALS AND METHODS: Following Ear-Nose-Throat examination and audiovestibular tests, the Dokuz Eylül University Meniere's Disease Disability Scale (DEU-MDDS) and Turkish version of the Dizziness Handicap Inventory (DHI-T) were administered to 93 patients with definite MD. Reliability and validity analyses of the scale were performed. RESULTS: There were 45 (48.4%) male and 48 (51.6%) female patients and the mean age was 48.9±12.1 years. Cronbach's alpha was 0.92 and intraclass correlation coefficients of the DEU-MMDS were significant (p<0.001). Results of the Goodness of Fit Statistics showed that the expression levels of the items were high and the correlation coefficients of each item with the scale were sufficient. There was a statistically significant correlation between DHI-T scores and MDDS. DEU-MDDS was not related to the vestibular tests, age or gender (p>0.05). CONCLUSION: The MDDS is a valid and reliable scale as a disease-specific quality of life questionnaire for patients with MD.

Stress and Unusual Events Exacerbate Symptoms in Menière's Disease: A Longitudinal Study.

HYPOTHESIS: Stress and unusual events are associated with a higher likelihood of attacks and increased symptom severity in Menière's disease (MD). BACKGROUND: MD is an unpredictable condition which severely impacts the quality of life of those affected. It is thought that unusual activity and stress may act as an attack trigger in MD, but research in this area has been limited to date. METHODS: This was a longitudinal study conducted over two phases. A mobile phone application was used to collect daily data on Menière's attacks and individual symptoms (aural fullness, dizziness, hearing loss, and tinnitus), as well as prevalence of unusual events (phase I), and stress levels (phase II). There were 1,031 participants (730 women, mean age 46.0 yr) in phase I and 695 participants (484 women, mean age 47.7 yr) in phase II. Panel data regression analyses were employed to examine for associations between unusual events/stress and attacks/symptoms, including the study of 24 hours lead and lag effects. RESULTS: Unusual events and higher stress levels were associated with higher odds of Menière's attacks and more severe symptoms. The odds of experiencing an attack were 2.94 (95% confidence interval [CI] 2.37, 3.65) with reporting of unusual events and increased by 1.24 (95% CI 1.20, 1.28) per unit increase in stress level. Twenty-four hour lead (OR 1.10 [95% CI 1.07, 1.14]) and lag (OR 1.10 [95% CI 1.06, 1.13]) effects on attacks were also found with increases in stress. CONCLUSION: This study provides the strongest evidence to date that stress and unusual events are associated with attacks and symptom exacerbation in MD. Improving our understanding of stress and unusual events as triggers in Menière's may reduce the uncertainty associated with this condition and lead to improved quality of life for affected individuals.