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

Yeo, Nicola, L.*; White, Mathew, P.*; Ronan, Natalie; Whinney, David, J.; Curnow, Alison*; Tyrrell, Jessica*

doi: 10.1097/MAO.0000000000001592

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.

*European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Truro

Ear, Nose and Throat Surgical Department, Torbay Hospital

Department of ENT Surgery, Royal Cornwall Hospital, Cornwall, UK

Address correspondence and reprint requests to Nicola L. Yeo, M.Sc., Room F37b, ECEHH, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK; E-mail:

Sources of support to be acknowledged: The authors would like to gratefully acknowledge Buzz Interactive, The Menière's Society, and the participants themselves for making this research possible.

Sources of Funding: The European Centre for Environment and Human Health (part of the University of Exeter Medical School) is partly financed by the European Regional Development Fund Programme 2007 to 2013 and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly. J.T. is supported by the Diabetes Research and Wellness Foundation. The UK Menière's Society assisted in patient recruitment. The funders had no role in the design, analysis, or interpretation of the data presented. The researchers are independent of the funders.

The authors disclose no conflicts of interest.

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