Factors influencing quality of life in patients with Ménière's disease, identified by a multidimensional approach

[Psychometric instruments for the diagnosis of tinnitus]

Tinnitus is a very complex phenomenon with various mechanisms of origin. Multimodal and interdisciplinary treatment is the most effective form of treatment for patients with chronic tinnitus. In order to assess existing comorbidity in tinnitus patients as well as to treat the patients individually, a comprehensive and differentiated diagnosis is needed. Since standardized guidelines for the use of relevant instruments in the diagnosis of tinnitus have been lacking hitherto, we present here psychometric questionnaires which have already been used effectively in the research, diagnosis and therapy of tinnitus in the present article. The questionnaires measure the severity of tinnitus, depression and anxiety, the perceived stress, personal resources as well as the quality of life of patients.

Cochlin expression in vestibular endorgans obtained from patients with Meniere's disease

The distribution of cochlin and its associated basement membrane proteins (collagen IV, collagen II, laminin-β2, and nidogen-1) were evaluated in the vestibular endorgans of subjects with Meniere's disease and compared with normal specimens. Cochlin mRNA expression in vestibular endorgans from Meniere's disease specimens was also investigated. Specimens were obtained from patients who had Meniere's disease and who were undergoing ablative labyrinthectomy. Control specimens were obtained both from autopsy specimens with documented normal audiovestibular function and from patients undergoing labyrinthectomy for acoustic neuroma excision. In the normal control specimens, cochlin immunoreactivity was found evenly distributed in the stroma of the cristae ampullaris and maculae of the utricle. In Meniere's specimens, cochlin immunoreactivity was markedly increased; this was associated with an increase in cochlin mRNA expression as shown by real-time reverse transcription with the polymerase chain reaction. Collagen IV and laminin-β2 immunoreactivity was significantly decreased in Meniere's specimens. Nidogen-1 and collagen II immunoreactivity was unchanged in Meniere's specimens when compared with normal samples. Cochlin upregulation has been implicated in the hereditary audiovestibulopathy, DFNA9. The increased expression of cochlin and decreased expression of collagen IV and laminin in Meniere's disease are suggestive that the overexpression of cochlin contributes to the dysfunctional inner ear homeostasis seen in this disease.

Meniere's disease: Still a mystery disease with difficult differential diagnosis

One hundred and forty-six years after its first description, the differential diagnosis of Meniere’s disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere’s disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus) is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere’s disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere’s disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.

Psychological resilience and long-term distress in Swedish and Icelandic parents' adjustment to childhood cancer

AIM

Studies of parental reactions to a child's cancer have traditionally been carried out within the framework of psychiatry and psychopathology. We studied the significance of individual resource factors strengthening parents' resilience to long-term cancer-related distress, a focus that has rarely been used.

PARTICIPANTS AND METHODS

The two-nation Nordic sample included 398 parents; 190 of whom had experienced a child's cancer, and 208 reference parents. We studied the sense of coherence (SOC) using the SOC-13 questionnaire. For assessing distress reactions we used a primarily illness-specific 11-dimensional Parental Psychosocial Distress in Cancer (PPD-C) self-report questionnaire developed for use with parents of childhood cancer patients, and the General Health Questionnaire (GHQ). Resilience was defined as absence of/less severe distress.

RESULTS

Low SOC was significantly associated with more severe distress in all dimensions of the PPD-C and GHQ. The protective effect of SOC was indicated by it being most negatively related to general psychiatric symptoms, physical and psychological stress symptoms, anxiety and depression. The influence of SOC varied with parents' gender, showing a stronger modifying influence among mothers. Mothers and fathers also differed in their utilisation of professional psychosocial support when confronted with the child's cancer.

CONCLUSION

Parental resilience to cancer-related distress varies with identifiable strength factors. A strengths-oriented approach helps in understanding parental adjustment to childhood cancer. In order to counteract psychological vulnerability, addressing resilience instead of pathology helps to identify parents at risk and in need of professional support when faced with a child's cancer.

Use of ICF in assessing the effects of Meniere's disorder on life

OBJECTIVES

We sought to determine the value of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) in subjects with Meniere's disorder in relation to their quality of life.

METHODS

We asked 228 members of the Finnish Meniere Federation to report the effects that Meniere's disorder had on their lives. The replies were classified on the basis of the ICF classification and related to the EuroQol 5D score and disease-specific impact. Logistic regression and decision tree analyses were used to determine the relationships.

RESULTS

Seventy percent of the patients listed impairments, 39% activity limitations, 47% participation restrictions, 16% effects on environmental contextual factors, and 28% effects on personal contextual factors. The EuroQol 5D score was explained by reported vertigo, anxiety, fatigue, restriction of life, and communication problems. The disease-specific impact was explained by episodes of vertigo, fatigue, communication problems, inability to work, restriction of life, and uncertainty of life. Both analysis models provided the same outcome variables, although the decision tree separated the results better (80%) into correct classes than did logistic regression analysis (60%).

CONCLUSIONS

Self-reported participation restriction, activity limitation, and personal contextual factors describe the limitations of general life in subjects with Meniere's disorder. The use of the ICF classification provides an instrument that can be used in enablement of subjects with Meniere's disorder.

Oxidative stress, redox homeostasis and cellular stress response in Ménière's disease: role of vitagenes

Ménière's disease (MD) is characterized by the triad of fluctuating hearing loss, episodic vertigo and tinnitus, and by endolymphatic hydrops found on post-mortem examination. Increasing evidence suggests that oxidative stress is involved in the development of endolymphatic hydrops and that cellular damage and apoptotic cell death might contribute to the sensorineural hearing loss found in later stages of MD. While excess reactive oxygen species (ROS) are toxic, regulated ROS, however, play an important role in cellular signaling. The ability of a cell to counteract stressful conditions, known as cellular stress response, requires the activation of pro-survival pathways and the production of molecules with anti-oxidant, anti-apoptotic or pro-apoptotic activities. Among the cellular pathways conferring protection against oxidative stress, a key role is played by vitagenes, which include heat shock proteins (Hsps) as well as the thioredoxin/thioredoxin reductase system. In this study we tested the hypothesis that in MD patients measurable increases in markers of cellular stress response and oxidative stress in peripheral blood are present. This study also explores the hypothesis that changes in the redox status of glutathione, the major endogenous antioxidant, associated with abnormal expression and activity of carbonic anhydrase can contribute to increase oxidative stress and to disruption of systemic redox homeostasis which can be associated to possible alterations on vulnerable neurons such as spiral ganglion neurons and consequent cellular degeneration. We therefore evaluated systemic oxidative stress and cellular stress response in patients suffering from Meniere's disease (MD) and in age-matched healthy subjects. Systemic oxidative stress was estimated by measuring protein oxidation, such as protein carbonyls (PC) and 4-hydroxynonenal (HNE) in lymphocytes of MD patients, as well as ultraweak luminescence (UCL) as end-stable products of lipid oxidation in MD plasma and lymphocytes, as compared to age-matched controls, whereas heat shock proteins Hsp70 and thioredoxin (Trx) expression were measured in lymphocytes to evaluate the systemic cellular stress response. Increased levels of PC (P < 0.01) and HNE (P < 0.05) have been found in lymphocytes from MD patients with respect to control group. This was paralleled by a significant induction of Hsp70, and a decreased expression of Trx (P < 0.01), whereas a significant decrease in both plasma and lymphocyte ratio reduced glutathione GSH) vs. oxidized glutathione (GSSG) (P < 0.05) were also observed. In conclusion, patients affected by MD are under condition of systemic oxidative stress and the induction of vitagenes Hsp70 is a maintained response in counteracting the intracellular pro-oxidant status generated by decreased content of GSH as well as expression of Trx. The search for novel and more potent inducers of vitagenes will facilitate the development of pharmacological strategies to increase the intrinsic capacity of vulnerable ganglion cells to maximize antidegenerative mechanisms, such as stress response and thus cytoprotection.

Disability and quality of life among community elderly with dizziness: report from the Ibadan study of ageing

BACKGROUND

Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing.

AIM

This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community.

SETTING AND DESIGN

Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria.

METHOD

Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment.

RESULT

Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65-69 years, 91 (28.6 per cent) 70-74 years, 66 (20.8 per cent) 75-79 years and 122 (38.4 per cent) > or =80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument.

CONCLUSION

Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

Anxiety and depression in head and neck out-patients

OBJECTIVES

To investigate the prevalence of psychological distress in head and neck out-patients.

DESIGN

We used the Hospital Anxiety and Depression Scale to screen 106 patients for mood disorders in a London head and neck ENT out-patient clinic.

SETTING

Queen's Hospital, Romford, UK.

PARTICIPANTS

One hundred and six patients attending a head and neck out-patient clinic.

MAIN OUTCOME MEASURE

Hospital Anxiety and Depression Scale score.

RESULTS

Approximately 39 per cent of patients had a possible anxiety disorder (10 per cent were rated as severe), and 27 per cent had possible depression (10 per cent were rated as severe).

CONCLUSION

We recommend that a member of the head and neck multidisciplinary team should be trained to identify and correctly refer psychologically distressed patients to appropriate existing psychiatric services.

Impact of bilaterality and headache on health-related quality of life in Meniere's disease

OBJECTIVES

We analyzed the impact of bilaterality and headache on the health-related quality of life (HRQL) of patients with Meniere's disease (MD).

METHODS

A case series including 86 patients with a diagnosis of definite MD according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) diagnostic criteria was evaluated by the Short Form 36 (SF-36) Health Instrument and the Dizziness Handicap Inventory Short Form (DHI-S).

RESULTS

The scores on all scales of the SF-36 were significantly lower for bilateral MD than for unilateral cases, except for body pain. Both groups had scores worse than those of their sex- and age-matched normative population on all SF-36 scales (p = 0.017 to p = 0.0001), except for body pain in men. The DHI-S scores were also better for unilateral than for bilateral cases (p = 0.04), suggesting that the dizziness is perceived to be more disabling in bilateral MD. Migraine was significantly associated with bilateral MD (odds ratio, 3.58 [95% confidence interval, 1.25 to 10.31]; p = 0.021). Headache and score on the AAO-HNS functional scale, which evaluates the effect of vertigo attacks on daily activities, were two independent factors that explained a great part of the variability on all SF-36 scales, except for "role emotional" in bilateral MD.

CONCLUSIONS

Patients with bilateral MD perceived their dizziness to be more disabling and had a worse HRQL than did patients with unilateral MD. Migraine was more frequently found in patients with bilateral involvement. Headache and score on the AAO-HNS functional scale were factors associated with the HRQL in bilateral MD.

Coping with Meniere's disease: experience and benefits from the use of complementary and alternative medicine

OBJECTIVES

To identify the significant events and persons prompting search for non-biomedical/complementary and alternative (CAM) ways to cope with the impact of Ménière's syndrome, the CAM therapies used and perceived benefits.

METHODS

A narrative-based approach, with participants recruited from web sites and newsletters of two Ménière's Societies (in the UK and in Victoria, Australia) and searches of a monthly newsletter, Spin, for letters related to the use of CAM therapies. A thematic approach to data analysis was undertaken.

RESULTS

Twenty personal, written stories were obtained and 23 letters. Commonly, critical events or changes in the condition provided the catalyst to seek alternative treatment, and sometimes significant others (a GP, CAM practitioner, friends, family). The accounts illustrate a range and variety of journeys that participants travelled in locating satisfactory ways to manage the condition, and the essential 'personal' nature of the experience and perceived benefits. No single CAM solution or pathway was evident.

DISCUSSION

The findings suggest the importance of 'finding your own way', having a positive outlook and being proactive in regaining control over one's health, and the value of early recommendations to 'perhaps try alternative/ CAM treatments'.

Predictive factors for development of severe tinnitus suffering-further characterisation

The purpose of this study was to identify risk factors for Severe Tinnitus Suffering (STS) and to describe the results from psychiatric diagnostic interviews of STS positive and STS negative patients. Consecutive tinnitus patients (n = 127) completed the Nottingham Health Profile (NHP) and the Tinnitus Severity Questionnaire (TSQ) and answered general health questions at the first visit to the clinic and at eighteen months follow-up. Twenty-four months after the first tinnitus consultation, standardized diagnostic interviews (SCID-P), according to DSM-IIIR, were performed by an experienced psychiatrist. The calculated probability for STS was 93%, if three items from the NHP (18,32,33) were positive. STS positive patients had more anxiety disorders with more psychosocial stress and lower global assessment of function scores. Results suggest that the NHP may be a useful tool in the clinical management of tinnitus patients and emphasises the importance of identifying depressive and anxiety disorders in this population.

Psychological assessment of patients with Menière's disease

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menière's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease.

Cognitions associated with anxiety in Ménière's disease

OBJECTIVES

The purpose of this longitudinal study was to identify cognitions associated with anxiety and maintenance of anxiety in people with Ménière's disease.

METHOD

At baseline, participants completed the Hospital Anxiety and Depression Scale (HADS), the Revised Illness Perception Questionnaire, the Dizziness Beliefs Scale, the Fear-Avoidance Beliefs Questionnaire, the Intolerance of Uncertainty Scale, and measures of demographic and illness characteristics. Participants were then randomized to a no-treatment group or to receive one of two self-help booklets, and completed the HADS again at 3-month follow-up.

RESULTS

After symptom severity had been controlled for, baseline anxiety was found to be associated with intolerance of uncertainty, fear-avoidance of physical activity, belief that dizziness would develop into a severe attack of vertigo, and several illness perception subscales (emotional representations, consequences, psychological causes, and perceived treatment effectiveness). Anxiety on follow-up was predicted by higher baseline levels of autonomic/somatic symptoms and intolerance of uncertainty, and by reporting less understanding of the illness. These longitudinal relationships were found in those who did and who did not receive self-help booklets.

CONCLUSIONS

Our findings suggest that intolerance of uncertainty is associated with anxiety in Ménière's disease. A controlled trial is needed to see whether anxiety might be reduced in Ménière's disease by helping patients tolerate and cope with uncertainty.

Antonovsky's sense of coherence scale and its relation with quality of life: a systematic review

The aim of this paper is to synthesise findings on the salutogenic concept, sense of coherence (SOC), and its correlation with quality of life (QoL). This study is descriptive and analytic, with a systematic integration of the contemporary knowledge base on the salutogenic research published in 1992-2003. This review includes 458 scientific publications and 13 doctoral theses on salutogenesis. In all, 32 papers had the main objective of investigating the relationship between SOC and QoL. This study is based on scientific publications in eight authorised databases, doctoral theses and available books. The SOC seems to have an impact on the QoL; the stronger the SOC, the better the QoL. Furthermore, longitudinal studies confirm the predictive validity of the SOC for a good QoL. The findings correspond to the core of the Ottawa Charter--that is, the process of enabling people to live a good life. Therefore, a certain possibility to modify and extend the health construct is becoming discernible, implicating a construct including salutogenesis and QoL. The SOC concept is a health resource, influencing QoL.

Psychiatric comorbidity in different organic vertigo syndromes

OBJECTIVE

A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigo syndromes and attributed to vestibular dysfunction. Yet almost no investigations exist which differentiate between various organic vertigo syndromes with regard to psychiatric comorbidity. The following prospective, interdisciplinary study was carried out to explore whether patients with different organic vertigo syndromes exhibit different psychological comorbidities.

METHODS

68 patients with organic vertigo syndromes (benign paroxysmal positioning vertigo (BPPV) n = 20, vestibular neuritis (VN) n = 18, Menière's disease (MD) n = 7, vestibular migraine (VM) n = 23) were compared with 30 healthy volunteers. All patients and control persons underwent structured neurological and neuro-otological testing. A structured diagnostic interview (-I) (SCID-I) and a battery of psychometric tests were used to evaluate comorbid psychiatric disorders.

RESULTS

Patients with VM and MD showed significantly higher prevalence of psychiatric comorbidity (MD = 57%, VM = 65%) especially with anxiety and depressive disorders, than patients with VN (22%) and BPPV (15 %) compared to normal subjects (20 %). These elevated rates of comorbidities resulted in significantly elevated odds-ratios (OR) for the development of comorbid psychiatric disorders in general (for VM OR = 7.5, for MD OR = 5.3) and especially for anxiety disorders (for VM OR = 26.6, for MD OR = 38.7).

CONCLUSION

As a consequence, a structured psychological and psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and prolonged vertigo courses, especially in patients with VM and MD. Possible reasons of these unexpected results in VM and MD are discussed.

Symptoms experienced by patients with peripheral vestibular disorders: evaluation of the Vertigo Symptom Scale for clinical application

OBJECTIVES

To describe symptoms during an episode of dizziness in a sample of patients suffering from peripheral vestibular disorders and to compare them with the items in the Vertigo Symptom Scale.

DESIGN

A descriptive study from a sample of patients with peripheral vestibular disorders.

SETTING

Patients visiting a department of audiology at a university hospital.

PARTICIPANTS

Twenty patients with peripheral vestibular disorders. The inclusion criteria were that the patient had had at least three spontaneous attacks of vertigo and/or was constantly unsteady during the last 3 months for at least 75% of the time when awake.

MAIN OUTCOME MEASURES

Patients were instructed to complete a diary where they recorded symptoms that arose during an episode of dizziness. These symptoms were compared with the content of the Vertigo Symptom Scale.

RESULTS

The most frequent symptoms as mentioned by the patients in their diaries were a feeling that things are spinning or moving around, nausea, feeling unsteady/about to lose one's balance, fatigue, headache, a feeling as if the ground you walk on is distant and ear-related such as tinnitus and a feeling of pressure in the ear. Pain in the heart or chest region, a heavy feeling in the arms or legs, pain in the lower part of the back and excessive sweating were not mentioned at all or by very few patients. Analysis showed that some of the symptoms included in the Vertigo Symptom Scale occurred less during an episode of dizziness than others in this sample of patients with peripheral vestibular disorders.

CONCLUSION

It was found that the Vertigo Symptom Scale is an adequate base but may need to be developed for use in patients diagnosed with peripheral vestibular symptoms to be able to evaluate care and treatment.

Improving the quality of life in patients with vestibular disorders: the role of medical treatments and physical rehabilitation

Vertigo, dizziness and imbalance are the main symptoms of vestibular disorders. They can lead to physical consequences, such as reduced postural control and falls, to psychologic/psychiatric consequences, such as anxiety-depression symptoms, panic and agoraphobia, and to cognitive defects, especially in the elderly. Consequently, the general health status and the quality of life (QoL) of vestibular patients can be significantly impaired. Several questionnaires have been developed in an attempt to quantify the degree of handicap and disability, the self-perceived health status and the quality of life in vestibular patients with dizziness and imbalance. Additionally, the main goal of the treatments of vestibular disorders should be to control symptoms, reduce functional disability and to improve patients' QoL. This article reviews the physical and psychological consequences of the vestibular disorders, their impact on the patients' QoL, and the treatment options, including drug prescriptions and vestibular rehabilitation protocols. A profile of the compound betahistine and its efficacy on QoL indices in the treatment of Menière's disease and other forms of peripheral vertigo is also presented.

Quality of life instruments in Ménière's disease

OBJECTIVE

Evaluate the sensitivity of quality of life (QoL) instruments over time in patients with Ménière's disease using general, symptom-specific, and disease-specific QoL instruments.

STUDY DESIGN

Prospective study using QoL instruments administered serially over 4 months in patients undergoing treatment for Ménière's disease.

METHODS

Sixty-one people aged 33 to 71 years with active, unilateral, cochleovestibular Ménière's disease refractory to medical management completed two general QoL instruments, Sense of Coherence (SOC) and World Health Organization Quality of Life-Abbreviated Version (WHOQOL-BREF), one symptom-specific QoL instrument, Vertigo Symptom Scale (VSS), and one disease-specific QoL instrument, Ménière's Disease Patient Oriented Severity Index (MDPOSI). All measures were administered at baseline and again 2 and 4 months later.

RESULTS

Disease- and symptom-specific instruments including the MDPOSI and VSS were positively correlated with vertigo control category (Pearson's R=0.345, MDPOSI; 0.279, VSS), indicating sensitivity to the frequency of vertigo spells. These instruments were also sensitive to changes in vertigo over time. Standardized response means showed greatest responsiveness to change on the MDPOSI (0.80) and the VSS (0.79). Standardized response means for SOC and WHOQOL-BREF were 0.03, and 0.32, respectively, suggesting poor responsiveness to change of symptoms. The VSS and MDPOSI were highly correlated (Pearson's r coefficient 0.744; P<.001).

CONCLUSIONS

A disease-specific QoL instrument such as the MDPOSI and a symptom-specific instrument such as the VSS more accurately reflect changes in control of vertigo in people with Ménière's disease over time than do general QoL instruments. These instruments can be used to determine the life impact of Ménière's disease and how aggressive therapy should be for the patient.

Patient baseline characteristics in an open-label multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study

OBJECTIVES AND METHODS

OSVaLD (Observational Study in patients suffering from recurrent peripheral vestibular Vertigo to Assess the effect of betahistine 48 mg/day on quality of Life and Dizziness symptoms) is a 3-month, open-label, multi-national post-marketing surveillance study of betahistine 48 mg/day in the management of patients with vertigo of less than 5 years in duration. The aim of the study is to examine the burden of disease associated with vertigo, as determined by scores on the Dizziness Handicap Inventory (DHI), Short Form-36 (SF-36) questionnaire and the Hospital Anxiety and Depression Scale (HADS). Changes in DHI, SF-36 and HADS scores between baseline and 3 months are used to assess the therapeutic effects of betahistine.

RESULTS

Participants (n = 2037) have been recruited from 13 countries in four continents (North and South America, Asia and Europe), representing a wide range of cultural and linguistic traditions. Approximately two-thirds of the patients are women. Sixty per cent of patients have diagnoses of peripheral vestibular vertigo of unknown pathology or benign paroxysmal positional vertigo; 13% have a diagnosis of Ménière's disease. All three of the instruments used characterize this as a population with extensive vertigo-attributable morbidity at baseline. The mean DHI score of the population is 63.7 +/- 15.7 (DHI scale: 0 = no handicap; 100 = major self-perceived handicap), SF-36 scores in all domains are below the population average for the USA and the HADS indicated that > 50% of patients exhibit symptoms of anxiety or depression or both, including 9% who have severe manifestations of either or both conditions.

CONCLUSIONS

This report describes the design and implementation of OSVaLD and presents baseline demographic and clinical features of the patients. Full results of the study, anticipated in 2007, will provide more details about the manifestations of vertigo in routine practice and the response to betahistine.

Molecular Changes Associated With the Endolymphatic Hydrops Model

HYPOTHESIS

Hearing loss and cochlear degeneration in the guinea pig model of endolymphatic hydrops (ELH) results, in part, from toxic levels of excitatory amino acids (EAAs) such as glutamate, which in turn leads to changes in the expression of genes linked to intracellular glutamate homeostasis and apoptosis, leading to neuronal cell death.

BACKGROUND

EAAs have been shown to play a role in normal auditory signal transmission in mammalian cochlea, but have also been implicated in neurotoxicity when levels are elevated. Changes in the expression of specific genes involved in the glutamatergic and apoptotic pathway would serve as evidence for excitotoxicity linked to elevated levels of glutamate.

METHODS

Guinea pigs underwent surgical obliteration of the endolymphatic duct, and then a timed harvest of the treated (right) and control (left) cochlea and subsequent quantification of gene expression via real-time quantitative polymerase chain reaction.

RESULTS

Quantitative polymerase chain reaction data show significant upregulation of glutamate aspartate transporter and neuronal nitric oxide synthase mRNA levels 3 weeks postsurgery and Caspase 3 mRNA levels 1 week postsurgery. No significant changes were detected in glutamine synthetase expression levels.

CONCLUSION

Upregulation of genes involved in glutamate homeostasis and the apoptotic pathway in animals treated with endolymphatic duct obstruction (usually associated with secondary ELH) support the hypothesis that EAAs may play a role in the pathophysiology of ELH-related cochlear injury. Inhibitors to these pathways can be useful for the study of new avenues to delay or prevent ELH-related hearing loss.

Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial

OBJECTIVE

This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease.

METHODS

Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months.

RESULTS

At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome.

CONCLUSIONS

Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Antonovsky's sense of coherence scale and the relation with health: a systematic review

STUDY OBJECTIVE

The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions.

DESIGN

The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses.

SETTING

Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books.

MAIN RESULTS

SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people's health but does not alone explain the overall health.

CONCLUSION

SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.

Tinnitus and Ménière's disease: characteristics and prognosis in a tinnitus clinic sample

The aim of this study is to describe tinnitus epidemiological characteristics in Ménière's disease (MD), the prognosis and its interaction with other MD symptoms. It is a descriptive transversal study. One hundred two MD patients were referred to a tinnitus clinic. Tinnitus was evaluated according to psychoacoustical tinnitogram, visual analogue scale, and tinnitus handicap inventory (THI). All patients were diagnosed with definitive MD (following AAO-HNS' 95 criteria). Pitch was more commonly identified in low and medium frequencies. Psychoacoustical intensity was matched in 12.7 dB. The visual analogue scale showed a value of 7.1, while THI score reached an average of 49%. Compared with other aetiologies (acoustic trauma, otosclerosis), MD showed a statistical difference in tinnitus severity parameters (P<0.05). Tinnitus increased VAS and THI score as a function of duration and bilateral disease (P<0.01). We found a statistical association (P<0.05) between tinnitus intensity and worse hearing loss or hyperacusis, but it was not influenced by number of vertigo spells. Higher MD stage increased tinnitus intensity and handicap. Tinnitus in MD patients referred to our tinnitus clinic presents a high intensity and handicap levels and represents the most troublesome symptom. Severity is influenced by the longer duration of the disease, the bilateral affection, hearing impairment or hyperacusis and a higher MD stage.

Oral Administration of Prednisone to Control Refractory Vertigo in Ménière's Disease: A Pilot Study

OBJECTIVE

To establish whether the oral administration of moderate doses of prednisone reduces refractory vertigo in Ménière's disease.

STUDY DESIGN

Blinded, randomized, controlled trial.

SETTING

Tertiary referral center.

PATIENTS

Patients with Ménière's disease with limited vertigo control (Class C) and severe disability (Scale 3).

INTERVENTIONS

Two groups (n = 8 per group) were treated orally with either diphenidol (25 mg/d) plus acetazolamide (250 mg/48 h) (control group), or the same treatment plus prednisone (0.35 mg/kg) daily for 18 weeks (prednisone group).

MAIN OUTCOME MEASURES

The variables evaluated were the frequency and duration of vertigo, tinnitus, aural fullness, and audiographic parameters. The clinical surveillance was performed for 12 months after prednisone withdrawal.

RESULTS

The frequency and duration of vertigo episodes were reduced by 50% and 30%, respectively, by prednisone treatment. Prednisone-treated patients manifested a significant reduction in tinnitus. No changes were observed in aural fullness or hearing. No metabolic or infectious disorders were observed.

CONCLUSION

Oral prednisone helps to control refractory vertigo in Ménière's disease. These preliminary data suggest that prednisone can be a good noninvasive antivertigo management regimen for these patients.

Radical scavengers for Ménière's disease after failure of conventional therapy: a pilot study

OBJECTIVE

To perform a trial to assess the efficacy of radical scavengers, i.e. rebamipide, vitamin C and glutathione, for the treatment of Ménière's disease (MD).

MATERIAL AND METHODS

Rebamipide (300 mg/day), vitamin C (600 mg/day) and/or glutathione (300 mg/day) were given orally for at least 8 weeks to 25 patients with poorly controlled MD.

RESULTS

Of 22 patients, 21 showed marked improvement of vertigo; 12/27 ears showed improvement of hearing disorders; 17/27 ears showed improvement of tinnitus; and 18/25 patients showed improvement of disability.

CONCLUSION

This study suggests that treatment using radical scavengers has the potential to become an effective new therapy for MD.