The influence of vertigo, hearing impairment and tinnitus on the daily life of Menière patients

Development and Validation of a Questionnaire to Assess the Effect of Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is an effective treatment for individuals experiencing imbalance and dizziness, helps to improve the quality of life. Lack of culturally valid questionnaires to assess the outcome from VRT necessitates the development of reliable and culturally valid questionnaire to measure the outcomes of VRT. Hence, the current study aimed to develop a culturally valid and reliable questionnaire for measuring the outcome of VRT in Indian population and to translate it into Malayalam and Kannada. This cross-sectional study was conducted at the department of Audiology and Speech Language Pathology of a tertiary care hospital. The questionnaire was constructed based on thorough literature search of existing questionnaires related to dizziness and vestibular disorders in relevant to the Indian context. Content validity was assessed by expert reviewers using a rating scale, and the questionnaire was translated into two south Indian languages (Malayalam and Kannada). The questionnaire was then administered on 12 patients undergoing VRT to assess its initial validation. The questionnaire was named as 'Effect of Vestibular Rehabilitation Therapy Questionnaire (EVRT-Q)', consisted of 25 questions divided into three domains: symptom, function, and emotion. The questionnaire demonstrated good content validity with a Content Validity Index greater than 0.8 for each question in all domains. The questionnaire possesses a high internal consistency when measured using Cronbach's alpha. Hence, the EVRT-Q appears to be a valid and reliable tool to assess the outcome from VRT in Indian population.

Bifenestral surgical and chemical labyrinthectomy, a new effective ablative surgical approach to intractable vertigo in Ménière Disease elderly Patients

INTRODUCTION

In this article, the bi-fenestral surgical chemical labyrinthectomy is introduced as a surgical demolition technique for treating resisting incurable forms of Meniere's disease in patients aged over 70 and/or with low hearing residues refractory to medical treatment.

MATERIALS AND METHODS

The results on participants fitting the inclusion criteria (n = 16) were reported using anamnesis (frequency of the crisis), Dizziness Handicap Inventory (DHI) and Functional Level Scale (FLS) before and after the intervention.

RESULTS

Vertigo control was achieved in all patients of this case series. A difference of 57 and 3.67 in mean DHI (from 68 (SD 16,7) to 11 (SD 14)) and FLS (from 4,68 (SD 0,7) to 0,1 (SD 0,3)) scores respectively were seen after an average of 16.28 months. Contextually tinnitus was reported to improve in seven patients (43,75%), aggravate in three (18,75%) and remain unchanged in the remaining six(37,5%).

CONCLUSION

Bi-fenestral surgical chemical labyrinthectomy appears a safe, immediate, and effective demolition treatment for vertigo control in a restricted class of patients affected by intractable Meniere disease.

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

OBJECTIVES

The aim of the present study was to investigate current treatment practices and self-reported effectiveness in Ménière's disease.

MATERIALS AND METHODS

Members of two Italian Ménière's disease support (n=170) with ≥6-month history of Ménière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life, work, or travel as included in the Social Life and Work Impact of Dizziness Questionnaire before and after recent treatments were queried.

RESULTS

Twenty-four different treatments were reported for Ménière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being the most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments, 78%-89% of respondents indicated limitations in family or social life, work, or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6±4.6, p<0.001), days off work per month (10.1±9.2 vs. 4.2±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (p<0.05 for all). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (p<0.01 for all), as well as the fewest respondents reporting post-treatment functional limitations (16%-37%).

CONCLUSION

Despite many treatment approaches targeting different proposed pathophysiology for Ménière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Ménière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Ménière's disease.

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.

What is Menière's disease? A contemporary re-evaluation of endolymphatic hydrops

Menière's disease is a chronic condition with a prevalence of 200-500 per 100,000 and characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus, aural pressure and a progressive loss of audiovestibular functions. Over 150 years ago, Prosper Menière was the first to recognize the inner ear as the site of lesion for this clinical syndrome. Over 75 years ago, endolymphatic hydrops was discovered as the pathologic correlate of Menière's disease. However, this pathologic finding could be ascertained only in post-mortem histologic studies. Due to this diagnostic dilemma and the variable manifestation of the various audiovestibular symptoms, diagnostic classification systems based on clinical findings have been repeatedly modified and have not been uniformly used in scientific publications on Menière's disease. Furthermore, the higher level measures of impact on quality of life such as vitality and social participation have been neglected hitherto. Recent developments of high-resolution MR imaging of the inner ear have now enabled us to visualize in vivo endolymphatic hydrops in patients with suspected Menière's disease. In this review, we summarize the existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging-based evaluation of patients with suspected Menière's disease. These indicate that endolymphatic hydrops is responsible not only for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as "vestibular" and "cochlear Menière's disease". As a consequence, we propose a new terminology which is based on symptomatic and imaging characteristics of these clinical entities to clarify and simplify their diagnostic classification.

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease

OBJECTIVES

To (1) examine the quality of life of individuals with Ménierè's disease in relation to symptom severity, social supports, and coping styles and (2) develop a prediction model to identify factors most strongly associated with quality of life.

METHODS

Data were collected using a web-based survey that included previously developed and validated measures (i.e. SF-12, Dizziness Handicap Inventory, Hearing Handicap Inventory for Elderly Screening Version, Iowa Tinnitus Handicap Questionnaire, Interpersonal Support Evaluation List, Brief COPES, Lehman's Quality of Life). Ninety-five individuals with Ménierè's disease who were members of one of five online Ménierè's disease support groups responded to the survey.

RESULTS

The findings indicated that symptom severity was negatively associated with patients' quality of life, social supports were positively associated with quality of life, and the use of negative coping styles (e.g. substance use, blaming) was negatively associated with quality of life. Four predictors (i.e. SF-12 mental health, dizziness severity, self-esteem support, and negative coping styles) accounted for 62% of the variance in quality of life.

DISCUSSION

The findings suggest that the factors associated with the quality of life of patients with Ménierè's disease are similar to those reported in the literature among patients with other chronic illnesses. The results also suggested that emphasis on psychosocial factors may be an important aspect of a comprehensive treatment intervention for individuals with Ménierè's disease.

Does radiation dose to the vestibule predict change in balance function and patient perceived dizziness following stereotactic radiotherapy for vestibular schwannoma?

OBJECTIVE

To date, the majority of the vestibular schwannoma (VS) literature has focused on tumor control rates, facial nerve function and hearing preservation. Other factors that have been shown to significantly affect quality-of-life (QOL), such as dizziness, remain understudied. The primary objective of the current study is to investigate the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported dizziness handicap.

MATERIALS AND METHODS

This is a prospective observational pilot study at a tertiary academic referral center including all subjects that underwent linear accelerator-based stereotactic radiotherapy (SRS) for sporadic VS and completed pre-treatment and post-treatment vestibular testing and Dizziness Handicap Inventory (DHI) questionnaires. Associations between objective vestibular test results, patient-reported DHI scores and radiation dose parameters were investigated.

RESULTS

Ten patients met inclusion criteria. Tumor control was achieved in all individuals. There were no statistically significant associations or identifiable trends between radiation dose and change in vestibular function or DHI scores. Notably, the four ears receiving the highest vestibular dose had minimal changes in vestibular function tests and DHI scores.

CONCLUSIONS

To the best of our knowledge, no previous reports have described the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported DHI. Based on these preliminary data, radiation dose to the vestibule does not reliably predict change in objective or subjective vestibular outcome measures.

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.

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.

Long-term symptoms in dizzy patients examined in a university clinic

Background

The long-term course of dizziness was investigated combining medical chart and survey data. The survey was undertaken median (interquartile range (IQR)) 4.6 (4.3) years after the initial medical examination.

Methods

Chart data comprised sex, age, diagnosis, symptom duration, postural sway and neck pain. Survey data comprised symptom severity assessed by the Vertigo Symptom Scale – Short Form (VSS-SF), and data regarding current state of dizziness, medication, neck pain and other chronic conditions.

Results

The sample consisted of 503 patients, the mean (standard deviation (SD)) age was 50.0 (11.6) years, women being slightly overrepresented (60%). Severe problems with dizziness (VSS-SF mean (SD) 13.9, (10.8)) were indicated in the total group and in 5 of 6 diagnostic sub-groups. Vertigo/balance- and autonomic/anxiety-related symptoms were present in all groups. Current dizziness was confirmed by 73% who had significantly more severe problems than the non-dizzy (VSS-SF mean (SD): 17.2 (10.1) versus 5.0 (7.3)). Symptoms were related to vertigo/balance more than to autonomic/anxiety (test of interaction p < 0.001).

Based on simple logistic regression analysis, sex, symptom duration, neck pain, sway and diagnoses predicted dizziness. Symptom duration and neck pain remained predictors in the adjusted analysis. Age, symptom duration, neck pain, sway and diagnoses predicted vertigo/balance-related dizziness in both regression analyses. Sex, neck pain and sway predicted development of autonomic/anxiety-related dizziness according to simple regression analysis, while only neck pain remained a significant predictor in the adjusted analysis. With respect to diagnosis, simple regression analysis showed significant reduced likelihood for development of dizziness in all vestibular sub-groups when compared to the non-otogenic dizziness group. With respect to vertigo/balance- and autonomic/anxiety-related symptoms, the implication of diagnostic belonging varied. No effect of diagnoses was seen in adjusted analyses.

Conclusion

The majority of patients had persistent and severe problems with dizziness. The wait-and-see attitude before referral to specialist institutions may be questioned. Early, active movements seem necessary, and attention should be paid to the presence of neck pain. Diagnoses had limited prognostic value. Questionnaire-based evaluations could assist in classification and identification of type of dizziness and thereby provide a better basis for specific rehabilitation.

Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure

A prototype self-report measure of vestibular rehabilitation outcome is described in a previous paper. The objectives of the present work were to identify the most useful items and assess their psychometric properties. Stage 1: One hundred fifty-five participants completed a prototype 36-item Vestibular Rehabilitation Benefit Questionnaire (VRBQ). Statistical analysis demonstrated its subscale structure and identified redundant items. Stage 2: One hundred twenty-four participants completed a refined 22-item VRBQ and three established questionnaires (Dizziness Handicap Inventory, DHI; Vertigo Symptom Scale short form, VSS-sf; Medical Outcomes Study short form 36, SF-36) in a longitudinal study. Statistical analysis revealed four internally consistent subscales of the VRBQ: Dizziness, Anxiety, Motion-Provoked Dizziness, and Quality of Life. Correlations with the DHI, VSS-sf, and SF-36 support the validity of the VRBQ, and effect size estimates suggest that the VRBQ is more responsive than comparable questionnaires. Twenty participants completed the VRBQ twice in a 24-hour period, indicating excellent test-retest reliability. The VRBQ appears to be a concise and psychometrically robust questionnaire that addresses the main aspects of dizziness impact.

Measuring outcome from Vestibular Rehabilitation, Part I: Qualitative development of a new self-report measure

Research suggests that Vestibular Rehabilitation (VR) is an effective treatment for dizziness, but there is currently no measure specifically designed to assess treatment outcome. A review of existing self-report measures of dizziness indicates that no measure has been designed for longitudinal application and all suffer from limitations which restrict their usefulness in measuring VR outcome. A need for a psychometrically robust patient-oriented measure of quality of life benefit from VR is identified. The aim of the present study was to explore dimensions relevant to VR with a view to developing a measure of outcome. Eighteen adults receiving VR participated in interviews about the quality of life impact of dizziness. Qualitative analysis revealed 64 themes describing self-perceived quality of life impact. Themes were developed into potential questionnaire items and 35 were selected to represent the quality of life impact of dizziness in a prototype questionnaire. A quarter of items in the prototype questionnaire refer to issues not addressed by existing measures; the remaining items draw together issues covered by the range of questionnaires currently in use.

Meniett therapy may avoid vestibular neurectomy in disabling Meniere's disease

CONCLUSION

In those patients for whom vestibular neurectomy has been selected due to the disabling recurrence of vertigo spells, Meniett therapy has been shown to allow avoidance of this surgical procedure in a fairly high percentage of patients with Meniere's disease (MD). Our data would also support a better result when pressure treatment is acting on MD of short duration.

OBJECTIVE

To test the possibility that low pressure treatment (Meniett) could avoid vestibular neurectomy in patients with MD that was refractory to medical treatment.

PATIENTS AND METHODS

The setting was a tertiary referral centre in a university hospital. Thirty-six MD patients, for whom vestibular neurectomy was indicated, underwent Meniett treatment and composed a group in which a long-term (>2 years) follow-up was achieved. Additionally, different durations of MD ('young' and 'old' MD) were distinguished and analysed separately.

RESULTS

Twenty-five patients (69.4%) were treated satisfactorily by using Meniett treatment and therefore avoided vestibular neurectomy. In half of them only one cycle of treatment was necessary.

Psychological Characteristics of Patients with Ménière's Disease Compared with Patients with Vertigo, Tinnitus, or Hearing Loss

An association between Ménierè's disease and psychological distress is frequently reported. Patients who do not have Ménière's disease but who have similar symptoms also experience various kinds of psychological disturbances. We conducted a study to investigate the relationship between Ménière's disease and personality traits, illness behavior, depression, and anxiety. We compared these factors in 77 patients who had Ménière's disease and 133 controls who did not have the disease but had one of its symptoms—either vertigo, tinnitus, or hearing loss. The mental status of study participants was assessed with standard tests. Patients in both groups had higher than normal levels of anxiety and neuroticism. The only significant difference between the two groups was a higher rate of extroversion in the Ménière's disease group. Minor differences emerged when Ménière's patients with tinnitus or vertigo were compared with similar controls. Relationships between psychological observations and otologic symptomatology or an otologic diagnosis were not specific, which illustrates the need to consider the role of illness behavior and personality as targets for psychological support or therapy associated with ENT treatment.

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.

Factors important for the measurement of social comparison in chronic illness: a mixed-methods study

OBJECTIVES

The aim of this study was to examine social comparison in illness using a mixed-methods approach that combined inductive exploration of how people used social comparison in this self-help group with a quantitative study of social comparison processes and their relationship to quality of life.

METHODS

The qualitative study involved 15 semi-structured interviews with people with Ménière's disease. Themes from the analysis of the interviews informed the development of the Social Comparison in Illness Scale (SCIS), which was then validated in a questionnaire study, in which participants with Ménière's disease (n = 196) completed the SCIS, the previously validated Identification/Contrast social comparison scale, and the SF-36 health status questionnaire.

RESULTS

The qualitative study uncovered a wide range of forms of social comparison, including upward, downward and lateral comparison on illness and coping dimensions, as well as comparing solely for informational purposes. The quantitative study indicated that these varied directions and dimensions of social comparison could be mapped onto five reliable categories that were related to quality of life: upward positive and downward positive comparison, upward negative and downward negative comparison, and comparing for information.

DISCUSSION

These analyses highlight the complexity of socially comparing in chronic illness, but also confirm the validity of the Identification/Contrast model of social comparison in this context.

Untreated Vestibular Schwannoma: Vertigo Is a Powerful Predictor Forhealth-Related Quality of Life

OBJECTIVE

The aim of the present study was to characterise the relation between quality of life (QOL) and the four major complaints (hearing loss, tinnitus, vertigo and unsteadiness) caused by unilateral vestibular schwannoma (versus) in a cohort of well-characterised untreated patients.

METHODS

One hundred and ninety-nine consecutive patients (91 men, 108 women) with a mean age of 56.9 years were studied prospectively during the 4-year period 2001–2004. The average time span from symptom onset to the radiological diagnosis was 4.2 years. The patients were subject to a standardised examination including MRI, evaluation of hearing acuity, balance function by stabilometry, and a visual analogue scale (VAS) self-evaluation of tinnitus and vertigo. Furthermore, the patients responded to two questionnaires, Short-Form 36 (SF-36) and Glasgow Benefit Inventory (GBI)). A reference population was recruited from 80 adult persons who visited Haukeland University Hospital as non-patients or non-staff members. All data were recorded prospectively in a customised case report form. Statistical analysis was done with SPSS software.

RESULTS

The response rates of the Short-Form 36 and Glasgow Benefit Inventoryquestionnaires were 91.5 and 89.9%, respectively. According to the SF-36 questionnaire the patients scored significantly below that of expected norms with exception of physical function and mental health. Patients report negative benefit on the general and physical sections of the GBI questionnaire. Regression analysis showed that vertigo had a strong negative impact on QOL, whilst unilateral hearing loss and tinnitus had less impact on QOL.

CONCLUSION

Vertigo is the symptom causing the most pronounced negative effect on QOL in patients with versus The more frequent versus-symptoms unilateral hearing loss and tinnitus seem to be less important in the patients' perception of QOL evaluated by the questionnaires used in this study. If vertigo could be relieved by treatment, this symptom should be more in focus when discussing treatment options in small to medium sized versus

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.

Terapia de reentrenamiento (TRT) en el acúfeno de la enfermedad de Ménière

OBJECTIVE

To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator).

DESIGN

Descriptive prospective study (EBM level 3).

PATIENTS

Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol.

MAIN OUTCOME MEASURES

Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI).

RESULTS

Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change.

CONCLUSIONS

TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.

Factors associated with quality of life in Menière's disease

The aim of this study was to identify the factors associated with better or worse quality of life in a sample of people with Menière's disease drawn from a UK self-help group (the Menière's Society) and to assess the forms of support on which the respondents could draw. A postal survey was sent to 1000 randomly selected group members, containing validated questionnaires assessing: (1) quality of life (the Short Form 36 (SF-36)); (2) factors that might predict quality of life; and (3) usage of resources provided to members by the Menière's Society. A total of 509 members completed the main survey, and 370 the second part of the survey. Factors associated with a less good quality of life included more severe vertigo, pressure in the ear, hearing loss and tinnitus, being younger, being female, living alone, having a lower occupational status and believing that the attitude of the consultant is unhelpful. Levels of vertigo severity in this sample were similar to those found in hospital samples, but it is possible that these respondents may differ in other respects from patients who do not join a self-help group.

Hearing outcome after concurrent endolymphatic shunt and vestibular nerve section

OBJECTIVE

To determine if endolymphatic shunt surgery concurrent with vestibular nerve section improves hearing outcome compared with vestibular nerve section alone.

STUDY DESIGN

Retrospective observational study with cross-sectional survey.

SETTING

Tertiary otologic private practice.

PATIENTS

Thirty-five patients who underwent vestibular nerve section and endolymphatic shunt surgery and 17 patients who had vestibular nerve section alone between 1985 and 2000.

METHODS

Chart review and correspondence for audiogram results and survey.

MAIN OUTCOME MEASURES

Hearing at last follow-up. Hearing Handicap Inventory, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and SF-36.

RESULTS

Eight patients in the vestibular nerve section and 15 in the vestibular nerve section and endolymphatic shunt surgery group had an audiogram at more than 16 months after surgery available for review. In the vestibular nerve section group, three patients had same hearing whereas five were worse. In the vestibular nerve section and endolymphatic shunt surgery group, 2 patients showed improvement, 2 were the same, and 11 were worse. There was no significant difference in the change from preoperative pure tone average or Word Discrimination Score to postoperative levels between the surgical groups. Eighteen patients had serviceable hearing preoperatively. Five of 8 in the vestibular nerve section and 4 of 10 in the vestibular nerve section and endolymphatic shunt surgery groups maintained serviceable hearing postoperatively. Of the 52 patients, 33 responded to the survey (63%). There were no significant differences between the groups for Dizziness Handicap Inventory, Hearing Handicap Inventory, Tinnitus Handicap Inventory, or SF-36, suggesting that patient-oriented outcomes are the same in both groups.

CONCLUSIONS

Concurrent endolymphatic shunt surgery and vestibular nerve section does not improve hearing or tinnitus outcome over vestibular nerve section alone.

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

PURPOSE

To evaluate self-reported quality of life in Ménière's disease patients by a multidimensional approach and to identify predictors of the results.

STUDY DESIGN

Cross-sectional.

SETTING

Tertiary referral hospital centers.

PATIENTS

One hundred-twelve patients with Ménière's Disease.

MAIN OUTCOME MEASURE

Questionnaires concerning quality of life: Short Form 12 (SF-12) including the Mental Component Summary (MCS-12) and the Physical Component Summary (PCS-12), Hospital Anxiety and Depression Scale (HAD), Sickness Impact Profile (SIP), the Function Level Scale (FLS) from the American Association of Otology's criteria for reporting results of treatment of Ménière's Disease, Vertigo Symptom Scale (VSS), Hearing Disability Handicap scale (HDHS), Tinnitus Severity Questionnaire (TSQ), and Sense of Coherence (SOC) Scale.

RESULTS

The Ménière's patients rated their quality of life significantly worse than did healthy reference groups in both the physical and the psychosocial dimensions. The SOC affected the results of the HAD, the MCS-12, and the psychosocial dimension of the SIP. The VSS affected the results of PCS-12, both dimensions of the SIP, and the FLS. The speech perception subscale of the HDHS affected the MCS-12, and tinnitus severity affected the HAD anxiety subscale. The results of the FLS correlated with the physical dimension of quality of life.

CONCLUSION

The Ménière's patients experienced a worse quality of life than did healthy subjects. Vertigo mainly influenced the physical dimension, whereas tinnitus and hearing loss influenced the psychosocial dimension. Sense of coherence had an impact on the psychosocial dimension. The FLS was not sensitive enough to serve as an outcome of treatment results but needed to be complemented by quality of life instruments.

Patients' subjective evaluations of quality of life related to disease-specific symptoms, sense of coherence, and treatment in Ménière's disease

OBJECTIVE

To evaluate the self-rated quality of life associated with vertigo, hearing loss, and tinnitus in Ménière's patients, and to identify potential relationships between these findings, treatment regimens, and sense of coherence in comparison to the classification of the American Academy of Otolaryngology-Head and Neck Surgery (AAO/HNS).

STUDY DESIGN

Cross-sectional.

SETTING

Tertiary referral hospital centers.

PATIENTS

112 patients with Méniére's disease, who had undergone endolymphatic sac surgery or intratympanic gentamicin injections, or were surgically untreated.

MAIN OUTCOME MEASURE

Questionnaires concerning quality of life aspects and symptom-specific instruments: the Vertigo Symptom Scale (VSS), the Hearing Disability Handicap scale (HDHS), the Tinnitus Severity Questionnaire (TSQ), the AAO/HNS criteria for reporting results of treatment of Ménière's disease, and the Sense of Coherence Scale.

RESULTS

A majority of the patients reported their quality of life in general as very good or good. There was no difference in general quality of life, present hearing loss, or tinnitus between the three treatment groups, but the gentamicin-treated patients had less vertigo than did the other groups. Sense of coherence showed a strong correlation to reported quality of life in all measurements.

CONCLUSIONS

Even though the gentamicin-treated patients had less vertigo, no difference in overall quality of life was found between the surgically treated and untreated patients. The sense of coherence seems to be an important factor in the patient's experience of quality of life. Quality of life instruments can measure both specific symptoms and related aspects on quality of life and may give complementary information to the AAO/HNS classification in evaluating the treatment of patients with Ménière's disease.

Prevalence of Meniere disease in Finland

OBJECTIVES

To assess the prevalence of Meniere disease in the population of 5 million in Finland according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommendation.

STUDY DESIGN

Retrospective investigation based on patient records of 306 patients treated for Meniere disease and recognized as such according to the International Statistical Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) in seven Finnish hospitals serving a population of 1.5 million people.

METHODS

Patients were selected from the computerized patient registers of outpatients and inpatients having received an appropriate diagnosis during the period from 1992 to 1996 and re-evaluated. Definite cases according to AAO-HNS guidelines were identified to calculate the prevalence of Meniere disease in Finland at the end of 1996.

RESULTS

A total of 131 definite cases of Meniere disease were identified. The prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence turned out to be higher (P<.001) in Northern areas (49/100,000) than in the south (38/100,000). The prevalence did not differ in the areas of university hospitals (44/100,000) from those of central hospitals (42/100,000).

CONCLUSIONS

The prevalence and incidence in Finland is lower than could be expected from previous international surveys, most of which provide inadequate data for forming a real picture of the epidemiology of Meniere disease. Uniform diagnostic criteria are indispensable for further research.