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.

Association between Ménière's disease and vestibular migraine.

OBJECTIVE: The aim of the present study was to evaluate complaints in people with Ménière's disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology. METHODS: The study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann-Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis. RESULTS: Migraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients. CONCLUSION: Our study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as 'MD with migraine' that will include patients with VM.

Association between Syncope and Tumarkin Attacks in Ménière's Disease.

OBJECTIVES: The aim of the current study was to further collect evidence that would confirm the hypothesis that vestibular drop attacks (VDAs) could cause syncope in patients with Ménière's disease (MD). MATERIALS AND METHODS: A cross-sectional survey design was employed in the present study. An Internet-based survey was administered on 602 individuals with MD. The mean age of the participants was 56.7 (25-75) years, and the mean duration of the disease was 12.4 (0.5-35) years. RESULTS: VDAs with varying severity were present among 307 (50.7%) patients and led to fall in 92 patients, and syncope occurred in 45 patients with VDA. The overall percentage of syncope due to MD was 4.7%. Factors, such as duration of disease, age, and gender of the patient, did not explain attacks of syncope. Migraine and headache were not associated with syncope. Syncope was witnessed in 23 and self-reported by 22 patients. Syncope was associated with frequent VDA, duration of VDA, and falls that occurred during VDA. Patients with syncope reported the experience as frightening, had reduced general health-related quality of life, had higher anxiousness scores, and suffered more from fatigue. They also experienced problems with work, employment, and social restrictions. CONCLUSION: Approximately 5% of patients with MD suffer from syncope, and syncope occurs among patients with VDA. In vestibular syncope, the sympathetic tone is lost, and baroreflex feedback is inhibited leading to fall and syncope. The consequences of vestibular syncope are severe, and patients face injuries and a significantly reduced quality of life.

Impact of Tumarkin attacks on complaints and work ability in Ménière's disease.

The purpose of the present study was to characterize the occurrence of Tumarkin attacks in patients with Ménière'sdisease (MD), and to study its association with reported complaints, severity of consequences, and also self-reported work ability. The study used a cross-sectional design. Data obtained from the Finnish Ménière Federation using an electronic survey was analyzed. 602 people with MD responded to the survey (62% response rate) with a mean age of 56.7 years and a mean duration of the disease 12.4 years. 49% of the respondents experienced Tumarkin attacks, which lasted for a few seconds to a few minutes. There were significant differences in complaints reported by MD patients with and without Tumarkin attacks. Respondents with Tumarkin attacks experienced various consequences, including tripping, falls, fear, anxiety, problems in dyadic life, and even transient loss of consciousness. Respondents with Tumarkin attacks had more frequently applied for pension than those not having Tumarkin attacks. On an average, respondents with Tumarkin attacks had less self-reported working ability when compared to those without Tumarkin attacks. The current study results suggest various differences in terms of complaints reported, severity of consequences, and the self-reported working ability in MD patients with and without Tumarkin attacks. Hearing healthcare professionals must examine Tumarkin attacks and their consequences in patients with MD during clinical examinations. In addition, the therapy should focus on alleviating the consequences and improving work ability.

Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project.

PURPOSE: Comprehensive phenotypical data across countries is needed to understand the determinants, prognosis and consequences of vestibular disease. The registry is a data repository for the members of the European DizzyNet. We report results from a pilot study using data from Turkey and Germany. METHODS: The pilot study included a convenience sample of patients aged 18 or above referred to Ege University Medical School Hospital, Dokuz Eylül University Hospital, Izmir, Turkey, and the German Center for German Center for Vertigo and Balance Disorders, University on Munich, Germany, with symptoms of vertigo or dizziness. Health-related quality of life was assessed with the EQ5-D and the Dizziness Handicap Inventory (DHI). To obtain comparable groups we matched data from the two countries for age, sex and diagnosis by propensity score. RESULTS: We included 80 adult patients, 40 from each country (60% female, mean age 54.1, SD 12.4). Matching was successful. Vestibular migraine (34%) was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (29%) and Menière's disease (12%). Clinical signs and symptoms were comparable in both countries. Patients from Turkey were more likely to report headaches (65 vs. 32%) and to show gait unsteadiness (51 vs. 5%). Patients from Germany reported significantly higher quality of life and lower values of the DHI score. CONCLUSIONS: Sharing data facilitates research, enhances translation from basic science into clinical applications, and increases transparency. The DizzyNet registry is a first step to data sharing in vestibular research across Europe.

Health-related quality of life in hearing-impaired adolescents and children.

OBJECTIVE: To evaluate health-related quality of life (HRQoL) in hearing-impaired adolescents and children and to compare it with that of hearing individuals. STUDY DESIGN AND SETTING: Hearing-impaired adolescents and children were recruited to the study during their annual control visit to the Hearing Clinic of Helsinki University Hospital. They filled in a HRQoL questionnaire, either the 16-dimensional 16D (adolescents aged 12-17 years) or the 17-dimensional 17D (children aged 7-11 years). The total HRQoL scores were compared with previously collected data, matched for age and gender, from adolescents and children without any known handicaps or illnesses. RESULTS: In total 50 adolescents and 50 children completed the questionnaire. Of the 16/17 dimensions of the HRQoL instrument, hearing and communication were affected the most. The total HRQoL scores were somewhat lower in adolescents and children with hearing impairment than in the general populations of age-matched peers (p < .001 for adolescents and .030 for children). CONCLUSIONS: HRQoL in hearing-impaired adolescents and children is only slightly worse than in hearing adolescents and children. SIGNIFICANCE: This study evaluates the impact of hearing loss on HRQoL to enhance the care of these children.

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.

Vestibular syncope: A disorder associated with drop attack in Ménière's disease.

OBJECTIVE: Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit. METHODS: During clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25-75 years). The duration of the disease was on average 9.8 years (range 0.5-35 years). RESULTS: In the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X2=16.7, p<0.001), migraine (X2=7.4, p<0.011), history of ischemic heart disease (X2=6.0, p<0.025), and history of cerebrovascular disease (X2=11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue. CONCLUSION: The current study indicates that patients with MD who suffer from Tumarkin attacks can suffer from syncope. It confirms the role of the otolith organ in controlling the circulatory homeostasis of the body. The actions are mediated through the vestibular sympathetic reflex.

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.

Patient-reported benefits from patient organization magazines and Internet-based peer support in Ménière's disease.

OBJECTIVES: To facilitate self-help, the Finnish Ménière's Federation (FMF) provides various kinds of support to persons with Ménière's disease (MD), which includes patient magazines (PM) and Internet-based peer support (iPS). The current study aimed to evaluate the benefits reported by MD patients in terms of PM and iPS. METHOD: The study used a cross-sectional survey design with a mixture of structured and open-ended questions administered online. A sample of 185 patients from the FMF membership database provided complete data. RESULTS: Ninety-two percent of the respondents rated PM as useful, or very useful. The main benefits of PM included: information on the disease and complaints, information about elements of peer support program, patient's experience with useful positive case studies, relevant news on MD, and information of activity of the FMF. Of the 185 persons, 68 reported that they did not have a need for peer support as their disease was either in silent phase or did not cause any annoyance. The main reasons for nonuse were: mild disease, personal reasons, and problems in using. Regarding the benefits of iPS, 75% of recent and 64% of chronic MD patients said that they would benefit from such a program. The main benefits of iPS included: reliable information on the disease and its management, peer support useful for coping with the disease, information about managing MD symptoms, information about managing attitude, and information about therapy. Moreover, the study identified different groups of individuals, which included: nonusers of support from patient organizations, those who used the support but did not feel they benefited, and those who used and also benefited from such programs. CONCLUSION: The current study results provide some information about the preferences of MD patients regarding different forms of support and could certainly prove helpful while developing wider support strategies.

Internet-Based Self-Help for Ménière's Disease: Details and Outcome of a Single-Group Open Trial.

PURPOSE: In this article, we present the details and the pilot outcome of an Internet-based self-help program for Ménière's disease (MD). METHOD: The Norton-Kaplan model is applied to construct a strategic, person-focused approach in the enablement process. The program assesses the disorder profile and diagnosis. In the therapeutic component of the program, the participant defines vision and time frame, inspects confounding factors, determines goals, establishes a strategy, and starts to work on the important problems caused by the disorder. The program works interactively, utilizes collaboration with significant others, and enhances positive thinking. Participants took part in an Internet-based self-help program. Data were collected interactively using open-ended and structured questionnaires on various disease-specific and general health aspects. The pilot outcome of 41 patients with MD was evaluated. RESULTS: The analysis of the pilot data showed statistically significant improvement in their general health-related quality of life (p < .001). Also, the outcome of the Posttraumatic Growth Inventory (Cann et al., 2010) showed small to moderate change as a result of the intervention. CONCLUSIONS: The Internet-based self-help program can be helpful in the rehabilitation of patients with MD to supplement medical therapy.

Internet-based peer support for Ménière's disease: a summary of web-based data collection, impact evaluation, and user evaluation.

OBJECTIVE: This paper presents a summary of web-based data collection, impact evaluation, and user evaluations of an Internet-based peer support program for Ménière's disease (MD). DESIGN: The program is written in html-form. The data are stored in a MySQL database and uses machine learning in the diagnosis of MD. The program works interactively with the user and assesses the participant's disorder profile in various dimensions (i.e., symptoms, impact, personal traits, and positive attitude). The inference engine uses a database to compare the impact with 50 referents, and provides regular feedback to the user. Data were analysed using descriptive statistics and regression analysis. STUDY SAMPLE: The impact evaluation was based on 740 cases and the user evaluation on a sample of 75 cases of MD respectively. RESULTS: The web-based system was useful in data collection and impact evaluation of people with MD. Among those with a recent onset of MD, 78% rated the program as useful or very useful, whereas those with chronic MD rated the program 55%. CONCLUSIONS: We suggest that a web-based data collection and impact evaluation for peer support can be helpful while formulating the rehabilitation goals of building the self-confidence needed for coping and increasing social participation.

Do patients with Ménière's disease have attacks of syncope?

The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.

Genome-wide association analysis reveals variants on chromosome 19 that contribute to childhood risk of chronic otitis media with effusion.

To identify genetic risk factors of childhood otitis media (OM), a genome-wide association study was performed on Finnish subjects, 829 affected children, and 2118 randomly selected controls. The most significant and validated finding was an association with an 80 kb region on chromosome 19. It includes the variants rs16974263 (P = 1.77 × 10(-7), OR = 1.59), rs268662 (P = 1.564 × 10(-6), OR = 1.54), and rs4150992 (P = 3.37 × 10(-6), OR = 1.52), and harbors the genes PLD3, SERTAD1, SERTAD3, HIPK4, PRX, and BLVRB, all in strong linkage disequilibrium. In a sub-phenotype analysis of the 512 patients with chronic otitis media with effusion, one marker reached genome-wide significance (rs16974263, P = 2.92 × 10(-8)). The association to this locus was confirmed but with an association signal in the opposite direction, in a UK family cohort of 4860 subjects (rs16974263, P = 3.21 × 10(-4), OR = 0.72; rs4150992, P = 1.62 × 10(-4), OR = 0.71). Thus we hypothesize that this region is important for COME risk in both the Finnish and UK populations, although the precise risk variants or haplotype background remain unclear. Our study suggests that the identified region on chromosome 19 includes a novel and previously uncharacterized risk locus for OM.

Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms 'vertigo' or 'dizziness' or 'vestibular and primary care' to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes.

Impact evaluation and association with EuroQol 5D health-related utility values in Ménière's disease.

The study was aimed at evaluating the validity of impact measures among patients with Ménière's disease (MD) with outcome variables of EuroQol generic health-related quality of life (HRQoL) measures (i.e., EQ-5D) by using Visual Analogue Scale (VAS) and EQ-5D index values. 183 members (out of 200 contacted) of the Finish Ménière Association returned the questionnaires that they had filled out. Various open-ended and structured questionnaires focusing on diagnostic aspects of symptoms and impairment caused by the disease were used. For activity limitation and participation restriction, standardized questionnaires were used. Open-ended questions on impact of the disease were asked, and subsequently classified based on the WHO-ICF classification. The general HRQoL was evaluated with EQ-5D index value and EQ VAS instruments. Correlation and linear regression analyses were used to explore the association between HRQoL and other aspects. Based on the explanatory power of different models the disease specific semeionic model provides the most accurate prediction in EQ-5D index calculations (38 % of the variance explained). In EQ VAS scores, HRQoL is most accurately determined by participation restriction (53 % of the variance explained), but the worst prediction was in ICF-based limitations (8 % of the variance explained). Interestingly, attitude and personal trait explained the reduction of HRQoL somewhat better than ICF-based variables. Activity limitation and participation restrictions are significant components of MD, but are less frequently recognized as significant factors in self-evaluating the effect of MD on the quality of life. The current study results suggest that MD patients seem to have problem identifying factors causing activity limitation and participation restrictions and hence use the semiotic description focusing on complaints.

Health-related quality of life in adults with hearing impairment before and after hearing-aid rehabilitation in Finland.

OBJECTIVE: The aim of this study was to evaluate health-related quality of life (HRQoL) in adults with hearing impairment in Finland before and after hearing rehabilitation. DESIGN: The study was prospective with hearing-aid rehabilitation as the intervention. The data was collected, using the 15D instrument, before and six months after hearing-aid rehabilitation. The data was analysed using t-tests and multiple linear regression methods. STUDY SAMPLE: The study sample included 949 adults with hearing impairment, and the control group included a sample of age- and gender-standardized general population. RESULTS: The study population had significantly poorer HRQoL on most dimensions of the 15D when compared to the control group both before and after hearing-aid rehabilitation. Hearing-aid rehabilitation resulted in improved mean scores on the dimensions of hearing and in the overall 15D score that were statistically significant, although the mean improvement in the overall score was marginal. Self-reported hearing ability can better predict the change in HRQoL, as a result of a hearing aid, when compared with measured hearing sensitivity. CONCLUSIONS: The study supports the hypothesis that on average, use of a unilateral hearing aid results in improved subjective hearing and marginal improvement in HRQoL in adults with hearing impairment.

Predisposition to Childhood Otitis Media and Genetic Polymorphisms within the Toll-Like Receptor 4 (TLR4) Locus.

BACKGROUND: Predisposition to childhood otitis media (OM) has a strong genetic component, with polymorphisms in innate immunity genes suspected to contribute to risk. Studies on several genes have been conducted, but most associations have failed to replicate in independent cohorts. METHODS: We investigated 53 gene polymorphisms in a Finnish cohort of 624 cases and 778 controls. A positive association signal was followed up in a tagging approach and tested in an independent Finnish cohort of 205 cases, in a British cohort of 1269 trios, as well as in two cohorts from the United States (US); one with 403 families and the other with 100 cases and 104 controls. RESULTS: In the initial Finnish cohort, the SNP rs5030717 in the TLR4 gene region showed significant association (OR 1.33, P = .003) to OM. Tagging SNP analysis of the gene found rs1329060 (OR 1.33, P = .002) and rs1329057 (OR 1.29, P = .003) also to be associated. In the more severe phenotype the association was stronger. This finding was supported by an independent Finnish case cohort, but the associations failed to replicate in the British and US cohorts. In studies on TLR4 signaling in 20 study subjects, the three-marker risk haplotype correlated with a decreased TNFα secretion in myeloid dendritic cells. CONCLUSIONS: The TLR4 gene locus, regulating the innate immune response, influences the genetic predisposition to childhood OM in a subpopulation of patients. Environmental factors likely modulate the genetic components contributing to the risk of OM.

Attitudes of significant others of people with Ménière's disease vary from coping to victimization.

OBJECTIVE: To explore the impact, reactions and coping methods of the significant others (SOs) of people with Ménière's disease (MD). DESIGN: SOs of people with MD were asked to answer open-ended questions reporting the 'life effects' and 'positive experiences' they have had as a result of the partner's condition. The replies to the 'life effects' question was categorized using the WHO-ICF framework. The responses of 'life effects' from this study and the 'positive experiences' reported in a recent study ( Manchaiah et al, 2013 ) were evaluated with K-means clustering analysis. STUDY SAMPLE: Eighty-eight SOs (42 male, 42 female, and four did not state gender). RESULTS: While the SOs mainly listed their own problems, a significant number of responses related to the problems of their partner. Personal perspectives tended to focus on the consequences of their partner's condition, whereas in perspectives of their partner they focussed on his/her symptoms. Further, replies from 81 SOs were used in evaluation of responses and were classified into four categories: constrained life attitude; disease burden attitude; care and support attitude; and social isolation attitude. CONCLUSIONS: The results of this study support the importance of including the SO of people with MD in the rehabilitation process.

Disease Profiling for Computerized Peer Support of Ménière's Disease.

BACKGROUND: Peer support is an emerging form of person-driven active health care. Chronic conditions such as Ménière's disease (a disorder of the inner ear) need continuing rehabilitation and support that is beyond the scope of routine clinical medical practice. Hence, peer-support programs can be helpful in supplementing some of the rehabilitation aspects. OBJECTIVE: The aim of this study was to design a computerized data collection system for the peer support of Menière's disease that is capable in profiling the subject for diagnosis and in assisting with problem solving. METHODS: The expert program comprises several data entries focusing on symptoms, activity limitations, participation restrictions, quality of life, attitude and personality trait, and an evaluation of disease-specific impact. Data was collected from 740 members of the Finnish Ménière's Federation and utilized in the construction and evaluation of the program. RESULTS: The program verifies the diagnosis of a person by using an expert system, and the inference engine selects 50 cases with matched symptom severity by using a nearest neighbor algorithm. These cases are then used as a reference group to compare with the person's attitude, sense of coherence, and anxiety. The program provides feedback for the person and uses this information to guide the person through the problem-solving process. CONCLUSIONS: This computer-based peer-support program is the first example of an advanced computer-oriented approach using artificial intelligence, both in the profiling of the disease and in profiling the person's complaints for hearing loss, tinnitus, and vertigo.