Self-Reported Effects of Ménière's Disease on the Individual's Life: A Qualitative Analysis

Symptom networks analysis among people with Meniere's disease: Application for nursing care

Objectives

This study aimed to explore and visualize the relationships among multiple symptoms in patients with Meniere's disease (MD) and aid clinical nurses in the design of accurate, individualized interventions.

Methods

This study included 790 patients with MD at the Eye and ENT Hospital of Fudan University from October 2014 to December 2021. A self-designed symptom checklist was used to assess 15 MD-related symptoms and construct contemporaneous networks with all 15 symptoms in R software. Qgraph package and Fruchterman-Reingold layout were used for network visualization. Bootstrapping methods were performed to assess network accuracy and stability, and three centrality indices were adopted to describe relationships among symptoms.

Results

Symptom networks showed good accuracy and stability. "Anxiety and nervousness"(98.2%), "aural fullness"(84.4%) and "tinnitus"(82.7%) were the common symptom in MD patients, while "tinnitus", "aural fullness" and "decline in word recognition", were more serious. MD patients with longer disease duration had higher prevalence and severity for all symptoms (P < 0.05). Symptom networks showed good accuracy and stability. "Decline in word recognition," "fatigue," and "anxiety and nervousness" were at the center of the symptom networks, which had the largest strength values and closeness. "Decline in word recognition," "headache," and "spatial discrimination and poor orientation" were the symptoms with the highest betweenness with the strongest bridging effect. The ≥1-year disease group exhibited higher centralities for "drop attack" and "anxiety and nervousness," and a lower centrality for "headache" compared with the <1-year disease group.

Conclusions

The symptom networks of MD patients with varying disease durations were revealed. Clinicians and nurses must provide precision interventions tailored to modifying symptom severity and centrality. Nursing interventions should focus on word recognition issues and associated discomfort in MD patients with multiple symptoms.

Worldwide Meniere's disease research: A bibliometric analysis of the published literature between 2002 and 2021

Background

In recent years, there has been an increasing number of publications on Meniere's disease. However, there are no bibliometric research on Meniere's disease. The purpose of this study was to find the focus and trends of Meniere's disease research through bibliometric approach.

Methods

Publications related to Meniere's disease in the Web of Science Core Collection (WOSCC) from 2002 to 2021 were collected. The bibliometric approach was used to estimate the searched data. Research foci of the studies were identified using VOSviewer and CiteSpace software.

Results

A total of 1,987 articles meet the inclusion criteria and are included in the study. In the past 20 years, the number of Meniere's disease publications is gradually increasing, especially in the past 3 years. The country with the largest contribution to Meniere's disease research is the United States, followed by Europe and Japan. High-frequency keywords included Meniere's disease, endolymphaic hydrops, vertigo, meniere-disease, inner ear, dizziness, symptoms, hearing, diagnosis, and tentamicin. The analyses of keyword burst direction indicate that evoked myogenic potential, MRI, and committee are emerging research hotspots.

Conclusion

This study provides an objective, systematic, and comprehensive analysis of Meniere's disease-related literature. In addition, we find a dramatic increase in studies in this field over the past 3 years. Evoked myogenic potentials and MRI may become the research hotspots of Meniere's disease in future. This study will help otolaryngologists, neurologists, and audiologists to clarify the research direction and potential hotspots of Meniere's disease and further help clinicians improve patients' prognosis.

[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.

Clinical Practice Guideline: Ménière's Disease Executive Summary

OBJECTIVE

Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE

The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

Clinical Practice Guideline: Ménière's Disease

OBJECTIVE

Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE

The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

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.

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.

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.

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.

Obstructive sleep apnea syndrome as a novel cause for Ménière's disease

PURPOSE OF REVIEW

Several recent reports have described the relation between sleep disorders and inner ear function. There are also many reports that insomnia is observed in Ménière's patients. However, the possibility that obstructive sleep apnea syndrome (OSAS) might affect Ménière's disease or other neurotological consequences was not noticed, until studies using polysomnography for these patients.

RECENT FINDINGS

OSAS may cause not only vestibular but also auditory dysfunction. Several reports suggest that insufficient supply of blood via the vertebral basilar artery, which supplies the inner ear, may cause hydropic distension of the endolymphatic system and lead to Ménière's disease. However, few people noticed that in OSAS this insufficient supply might be exacerbated in the night while patients are sleeping. Even more, we should note that Ménière's patients may not only suffer from insomnia, but also that the impaired sleep might be caused by OSAS.

SUMMARY

Physicians routinely prescribe benzodiazepines or other drugs that have hypnotic, muscle relaxing, antianxiety, and anticonvulsant properties for insomnia, but these properties may have the effect of aggravating OSAS symptoms. Continuous positive airway pressure (CPAP) is an effective therapy used worldwide for the treatment of OSAS. CPAP or surgeries for OSAS may also be useful as one aspect of treatment for Ménière's disease patients with OSAS.

The consequences of tinnitus in long-standing Ménière's disease

OBJECTIVE

To explore the perceived consequences of tinnitus in patients with long-standing Ménière's disease (MD).

METHOD

A questionnaire-based cross-sectional investigation of 183 randomly selected members of the Finnish Ménière's Federation. It assessed general health related quality of life (EQ-5D), a participation restriction scale, self-listed consequences and a rating of effects of MD on life.

RESULTS

When the effects of the other cardinal symptoms of Ménière's disease were partialled out, the main reported impacts of tinnitus related to anxiety, sleep and depression. It also contributed to some difficult listening situations and to interactions with significant others. Tinnitus explained a significant component of disease-specific quality of life (QoL), but did not relate significantly to the generic measures used. However, the measure 'mood' in the QoL scale was significantly associated with severe tinnitus.

CONCLUSION

The most important specific impacts of tinnitus in chronic Ménière's disease relate to broadly psychological factors and mood.

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.