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

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

The Weather and Ménière's Disease: A Longitudinal Analysis in the UK.

HYPOTHESIS: Changes in the weather influence symptom severity in Ménière's disease (MD). BACKGROUND: MD is an unpredictable condition that significantly impacts on quality of life. It is suggested that fluctuations in the weather, especially atmospheric pressure may influence the symptoms of MD. However, to date, limited research has investigated the impact of the weather on MD. METHODS: In a longitudinal study, a mobile phone application collected data from 397 individuals (277 females and 120 males with an average age of 50 yr) from the UK reporting consultant-diagnosed MD. Daily symptoms (vertigo, aural fullness, tinnitus, hearing loss, and attack prevalence) and GPS locations were collected; these data were linked with Met Office weather data (including atmospheric pressure, humidity, temperature, visibility, and wind speed). RESULTS: Symptom severity and attack prevalence were reduced on days when atmospheric pressure was higher. When atmospheric pressure was below 1,013 hectopascals, the risk of an attack was 1.30 (95% confidence interval: 1.10, 1.54); when the humidity was above 90%, the risk of an attack was 1.26 (95% confidence interval 1.06, 1.49). CONCLUSION: This study provides the strongest evidence to date that changes in atmospheric pressure and humidity are associated with symptom exacerbation in MD. Improving our understanding of the role of weather and other environmental triggers in Ménière's may reduce the uncertainty associated with living with this condition, significantly contributing to improved quality of life.

The Cost of Ménière's Disease: A Novel Multisource Approach.

OBJECTIVES: To estimate the annual cost of Ménière's disease and the cost per person in the UK population and to investigate the direct and indirect costs of the condition. DESIGN: The authors utilized a multidata approach to provide the first estimate of the cost of Ménière's. Data from the UK Biobank (a study of 500,000 individuals collected between 2007 and 2012), the Hospital Episode Statistics (data on all hospital admissions in England from 2008 to 2012) and the UK Ménière's Society (2014) were used to estimate the cost of Ménière's. Cases were self-reported in the UK Biobank and UK Ménière's Society, within the Hospital Episode Statistics cases were clinician diagnosed. The authors estimated the direct and indirect costs of the condition, using count data to represent numbers of individuals reporting specific treatments, operations etc. and basic statistical analyses (χ tests, linear and logistic regression) to compare cases and controls in the UK Biobank. RESULTS: Ménière's was estimated to cost between £541.30 million and £608.70 million annually (equivalent to US $829.9 to $934.2 million), equating to £3,341 to £3,757 ($5112 to $5748) per person per annum. The indirect costs were substantial, with loss of earnings contributing to over £400 million per annum. CONCLUSIONS: For the first time, the authors were able to estimate the economic burden of Ménière's disease. In the UK, the annual cost of this condition is substantial. Further research is required to develop cost-effective treatments and management strategies for Ménière's to reduce the economic burden of the disease. These findings should be interpreted with caution due to the uncertainties inherent in the analysis.

Mental Health and Subjective Well-being of Individuals With Ménière's: Cross-sectional Analysis in the UK Biobank.

HYPOTHESIS: Ménière's disease significantly impacts on an individual's mental health and subjective well-being (SWB). BACKGROUND: Ménière's disease is an unpredictable illness that impacts on mental health. The symptom triad of vertigo, tinnitus, and hearing loss all contribute to the disabling nature of the condition. To date, limited research has investigated the mental health and SWB impact of Ménière's disease. METHODS: We investigated the mental health and SWB of 1,376 Ménière's sufferers in the UK Biobank and compared this to over 500,000 controls. Participants in the Biobank were asked 38 questions pertaining to mental health and SWB. We utilized crude and adjusted linear and logistic regression to investigate the association between Ménière's and mental health and SWB. We also investigated how mental health and SWB might be related to length of diagnosis to see whether people might adapt to Ménière's over time. RESULTS: Ménière's was associated with increased frequency of depression, tiredness, tenseness, and unenthusiasm in the 2 weeks before recruitment. Ménière's was associated with longer periods of depression than controls (10.2 wk [95% CI: 5.2-15.2 wk]). Reduced health satisfaction was associated with Ménière's, but in other aspects of life (general happiness, work, family, friends, financial), individuals with Ménière's were as happy as controls. Mental health and SWB in individuals diagnosed for longer was better than in those who were recently diagnosed suggesting at least partial adaptation. DISCUSSION: This is the largest population study investigating the mental health impact of Ménière's. Our findings suggest that Ménière's adversely impacts on mental health, an individual's emotional state, and their life satisfaction. However, our findings raise the importance of supporting social relations for people with Ménière's and that although a cure is not currently available, we can still learn much about the adaptation strategies developed by long-term sufferers to help individuals with new diagnoses.

Associations of Leg Length, Trunk Length, and Total Adult Height With Ménière's: Cross-Sectional Analysis in the UK Biobank.

OBJECTIVES: To investigate whether adverse intrauterine and/or childhood exposures, using established anthropometric measures (e.g., components of adult height, including total height, leg length, and trunk length) as a proxy for childhood exposures, are associated with self-reported Ménière's disease. DESIGN: Cross-sectional data from the UK Biobank were used to compare 1,327 self-reported Ménière's cases with 479,500 controls. The authors used logistic regression models to investigate the relation of Ménière's disease with the components of adult height. Models were adjusted for a range of potential confounders including age, sex, body mass index, ethnicity, type 2 diabetes, coronary heart disease, and socioeconomic status. RESULTS: In the UK Biobank, Ménière's was inversely associated with overall stature (odds ratio [OR] per standard deviation increase in height, 0.87; 95% confidence interval [CI], 0.80-0.94) and leg length (OR, 0.88; 95% CI, 0.82-0.94) in fully adjusted models. No association was noted in adjusted models with trunk length (OR, 0.94; 95% CI, 0.88-1.01). CONCLUSIONS: The specific association between leg length, a potential marker of adverse childhood environments, and Ménière's may suggest that early-life environmental exposures that influence skeletal growth may also influence the risk of developing Ménière's in later life.

Patient satisfaction with postaural incision site.

Introduction. Controversy exists over the optimum incision placement when performing ear surgery via the postauricular approach. Little is known about the impact of incision placement on future comfort in wearing audio or visual aids or the effect on the minor auricular muscles cut in the approach. Objective. (1) To establish patient satisfaction with their postauricular surgical incision, and to establish the impact on comfort wearing hearing or visual aids. (2) To establish whether patients' voluntary ear movements were affected by surgery. Materials and Methods. In January 2014, questionnaires were sent to 81 patients who underwent mastoid surgery requiring a postauricular incision between January 2004 and December 2012. The incision placement was broadly the same for all patients as they were operated on by the same surgeon (or under his supervision). The incision is sited far posteriorly at the hairline. Results. 42 (52%) of the patients contacted responded. 80% of patients wearing glasses reported no discomfort or problems associated with their incision. 82% of patients who wear hearing aids were comfortable. Only 1 of the 5 patients who could move their ears preoperatively noticed a change afterwards. Conclusion. A hairline incision is well tolerated by most of the patients.

Prevalence, associated factors, and comorbid conditions for Ménière's disease.

OBJECTIVES: The aims of this study were to estimate the prevalence of Ménière's disease and investigate its relationship with: demographic factors; symptoms and conditions that are known or hypothesized to be associated with Ménière's disease; other physical diseases; mental health. DESIGN: The authors used cross-sectional data from the UK Biobank to compare 1376 self-reported Ménière's participants with over 500,000 without Ménière's. The data set has comprehensive anthropometric measures, questionnaire data investigating health, well-being, diet, and medical and drug-prescribing history for each participant. The authors used logistic regression models to investigate the relationship of Ménière's disease with: demographic factors; symptoms and conditions that are known or hypothesized to be associated with Ménière's disease; other physical diseases; and mental health. RESULTS: Ménière's disease was more common in participants who were older (adjusted odds ratio per 10-year increase: 1.5 [95% confidence interval:1.4-1.6]), white (odds ratio: 1.7;1.2-2.3), female (1.4;1.3-1.6), and having higher body mass index categories (p < 0.001). The Ménière's group had greater odds of hearing difficulty (10.9;9.6-12.5), current tinnitus (68.3;47.8-97.5), and had fallen more than once in the last year (2.1;1.8-2.5). Ménière's participants had greater odds of reporting at least one disease from each grouping of allergic, immune dysfunction, or autonomic dysfunction (2.2;1.8-2.6), and poor mental health (2.1;1.8-2.5). CONCLUSIONS: This study provides an evidence base that improves understanding of Ménière's disease. Associations were noted with a number of diseases, and the authors hypothesize a role for the autonomic nervous system and immune system dysfunction in Ménière's etiology. The study also highlights the physical and mental health correlates of the condition.

Using keywords to predict the need for an audiogram: an analysis of referral letters using logistic regression.

BACKGROUND: Otolaryngology clinics are often booked without considering the distribution of work for doctors and audiologists. This causes inefficiencies of time and human resources. This may be due to clinics being booked before referrals have been triaged to identify whether a hearing test, known as a pure tone audiogram (PTA), is indicated. A model that can predict the need for PTA without clinician-led triage could be useful to address these booking issues. OBJECTIVE: To establish if it is possible to predict whether a referred patient requires a PTA based on occurrences of words in the referral letter. METHOD: Binary logistic regression analysis of 500 letters of referral for otolaryngology outpatients. The derived model was then tested on 50 referral letters. All the referral letters were reviewed by clinicians and classified according to whether or not a PTA would be required. RESULTS: The regression model correctly predicted requirement for a PTA in 42 of 50 referral letters (84%), with a sensitivity of 91% and specificity of 82%. CONCLUSION: The model is able to predict requirement for a PTA from referral letters with a high degree of accuracy. This method may have a role in assisting administrative/clerical staff or non-specialist clinicians to book appropriate ear, nose and throat (ENT) clinic appointments, with or without a PTA. As a result, workload would be distributed more evenly, through the clinic for both otolaryngologists and audiologists, increasing efficiency.

Considerations for design of future cochlear implant electrode arrays: electrode array stiffness, size, and depth of insertion.

The level of hearing rehabilitation enjoyed by cochlear implant (CI) recipients has increased dramatically since the introduction of these devices. This improvement is the result of continual development of these systems and the inclusion of subjects with less severe auditory pathology. Developments include advanced signal processing, higher stimulation rates, greater numbers of channels, and more efficient electrode arrays that are less likely to produce insertion damage. New directions in the application of CIs, particularly in combined acoustic and electrical stimulation, and increasing performance expectations will place greater demands on future electrode arrays. Specifically, the next generation of arrays must be reliably inserted without damage, must maintain residual acoustic function, and may need to be inserted more deeply. In this study, we measured the mechanical properties of eight clinical and prototype human CI electrode arrays and evaluated insertion trauma and insertion depth in 79 implanted cadaver temporal bones. We found that the size and shape of the array directly affect the incidence of observed trauma. Further, arrays with greater stiffness in the plane perpendicular to the plane of the cochlear spiral are less likely to cause severe trauma than arrays with similar vertical and horizontal stiffness.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I: Comparison of Nucleus banded and Nucleus Contour electrodes.

In recent years, new designs of cochlear implant electrodes have been introduced in an attempt to improve efficiency and performance by locating stimulation sites closer to spiral ganglion neurons and deeper into the scala tympani. The goal of this study was to document insertion depth, intracochlear position and insertion trauma with the Nucleus Contour electrode and to compare results to those observed with the earlier generation Nucleus banded electrode. For this comparison eight Nuclears banded electrodes and 18 Contour electrodes were implanted in cadaver temporal bones using a realistic surgical exposure. Two experienced cochlear implant surgeons and two otology fellows with specialized training in cochlear implant surgery were selected for the study to represent a range of surgical experience similar to that of surgeons currently performing the procedure throughout the world. Following insertion of the electrodes, specimens were imaged using plain film X-ray, embedded in acrylic resin, cut in radial sections with the electrodes in place, and each cut surface was polished. Insertion depth was measured in digitized X-ray images, and trauma was assessed in each cross-section. The Contour electrode inserted more deeply (mean depth=17.9 mm or 417 degrees ) than the banded electrode (mean depth=15.3 mm or 285 degrees ). The incidence and severity of trauma varied substantially among the temporal bones studied. However, the nature and frequency of injuries observed with the two devices were very similar. The Contour electrode was clearly positioned closer to the modiolus than the banded model, and also appeared easier to use. Based on this difference in position and data from previous studies we conclude that the Contour electrode may provide lower thresholds and improved channel selectivity, but the incidence of trauma remains a problem with the newer design. The relative influences of electrode positioning and neural degeneration that may result from trauma are as yet unclear.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. II: Comparison of Spiral Clarion and HiFocus II electrodes.

In recent years, several new designs of cochlear implant electrodes have been introduced clinically with the goal of optimizing perimodiolar placement of stimulation sites. Previous studies suggest that perimodiolar electrodes may increase both the efficiency and performance of a cochlear implant. This is the second of two studies designed to examine the positioning of electrodes and the occurrence of insertion-related injury with these newer designs and to directly compare two perimodiolar electrodes to their predecessors. In our previous report we compared the Nucleus banded electrode with the Nucleus Contour perimodiolar electrode. In the present study, using the same protocol, we examine the Spiral Clarion electrode and its successor, the HiFocus II electrode with attached positioner. Eight Spiral Clarion arrays and 20 HiFocus II electrodes with positioners were inserted into human cadaver temporal bones. Following insertion, the specimens were embedded in acrylic resin, cut in quarters with a diamond saw and polished. Insertion depth, proximity to the modiolus and trauma were evaluated in X-ray images and light microscopy. The newer electrode was consistently positioned closer to the modiolus than the previous device whereas the angular depth of insertion measured for the two electrodes was similar. The incidence of trauma was minimal when either electrode was inserted to a depth of less than 400 degrees . However, severe trauma was observed in every case in which the HiFocus II with positioner was inserted beyond 400 degrees and in some cases in which the Spiral Clarion was inserted beyond 400 degrees . To evaluate the possible role of electrode size in the trauma observed we modeled both devices relative to the dimensions of the scala tympani. We found that the fully inserted HiFocus II electrode with positioner was larger than the scala tympani in approximately 70% of temporal bones measured. The results suggest that both the Clarion spiral and HiFocus II with positioner can be inserted with minimal trauma, but in many cases not to the maximum depth allowed by the design.