Meniere's Disease Quality of Life

A University of California-San Diego study highlights disease's impact on physical and mental health

Orlando, FL -- Meniere's disease is a chronic illness that often affects individuals in the prime of life. Many believe the disorder has a serious impact on the psychosocial status of individuals and their families. For the first time, a new study quantifies health-related quality of life status of patients with Meniere's disease who have failed conventional medical therapy and are candidates for further intervention and compares their status with other medical disorders described in a similar fashion.

Early studies suggested that there was a psychosomatic component in the etiology of this disorder. Now, it is generally accepted that the psychological aspects of the illness are in fact the consequence of the disease itself. A number of studies have shown Meniere's disease is associated with anxiety, depression and inability to concentrate.

The authors of the study, "Impact of Meniere's Disease on Quality of Life," are Jeffrey P. Harris, MD, PhD, from the Division of Otolaryngology-Head & Neck Surgery, and John P. Anderson, PhD, Department of Family and Preventive Medicine, at the University of California-San Diego. Their findings were presented before the American Otologic Society, meeting May 13-15, in Orlando, FL.

Methodology: Nineteen patients (12 female, seven male, age 32 to 83 yrs); all had been diagnosed with Meniere's disease that had been resistant to medical therapy; the baseline interviews on the subjects were performed by trained interviewers prior to any medical intervention.

Three instruments were used in the study:

Quality of Well-being Scale (QWB): A quantitative general health measure that allows for comparison of all diseases or conditions. It permits an analysis of programs, policies and treatments for the specified diseases and conditions, and allows calculation of Quality-Adjusted Life Years gained or lost by affected individuals. Patients are asked about their experience and dysfunction for each of the past six consecutive days. They are asked to define their symptom/problem complex - (headache, dizziness, ringing in ears), using criteria such as mobility scale-e.g. limitations in travel, physical activity scale-e.g. in bed, and social activity scale- e.g. working, housework.

Medical Outcomes Study SF-12: Widely employed general health status measure. This research tool rates physical and mental status by asking how often or how troublesome described situations are either during the past week or ongoing.

Center for Epidemiologic Studies-Depression Scale (CES-D): This is a widely used measure of psychological depression. Generally, 20 items rated on a scale of 0-3 over the past week: zero (best) to 60 (worst). Scores 16 or above indicate clinically significant depression).

Results: The study revealed the following:

-- QWB scores: Meniere's patients achieved a mean score of .505 on days of acute episodes and .620 on days without acute episodes. This compares with scores of normal adults (.810), very ill adults with life-threatening illness (cancer, AIDS (.616), non-institutionalized Alzheimer's patients (.506), and AIDS & cancer patients, six days before death (.427). This indicates that Meniere's patients lost 43.9% from optimum well-being or .439 quality adjusted life years lost for each year in their QWB state. This score reflects major impairment in mobility, physical activity, social activity and clear thought processes.

-- CES-D scores: Meniere's patients registered a mean CES-D score of 23 (significant depression 16 and above). This compares with trauma patients (CES-D 20), cochlear implant candidates (CES-D 15), patients with post-cochlear implantation (CES- D 12)

-- SF-12 scores: Meniere's patients recorded scores SF-12 physical- 38.9 (mean 50, + 10) and SF-12 mental- 44.2 ( mean 50, + 10). Meniere's disease patients are among the most severely impaired non-hospitalized patients studied thus far. These patients exhibit even more impairment on days with acute episodes. Patients describe impairment in travel, ambulation, work and other major social roles as well as trouble learning, remembering and thinking clearly. They are clinically depressed as a group.

Conclusions: The degree of impairment and depression which stems from this condition becomes the responsibility of treating physicians to develop and offer treatment options to their Meniere's patients. The authors call on the medical community and fellow specialists to not condone a nihilistic approach to treatment, stress to primary care colleagues that this condition requires treatment, and seek out effective treatment strategies for this debilitating illness.

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