Yeo Nicola L, White Mathew P, Ronan Natalie, Whinney David J, Curnow Alison, Tyrrell Jessica
European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Truro.
Ear, Nose and Throat Surgical Department, Torbay Hospital.
Otol Neurotol. 2018 Jan;39(1):73-81. doi: 10.1097/MAO.0000000000001592.
Stress and unusual events are associated with a higher likelihood of attacks and increased symptom severity in Menière's disease (MD).
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.
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.
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.
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.
压力和异常事件与梅尼埃病（MD）发作的可能性增加及症状严重程度加重相关。
梅尼埃病是一种不可预测的疾病，严重影响患者的生活质量。人们认为异常活动和压力可能是梅尼埃病发作的触发因素，但该领域的研究至今仍很有限。
这是一项分两个阶段进行的纵向研究。使用手机应用程序收集有关梅尼埃病发作和个体症状（耳胀满感、头晕、听力损失和耳鸣）的每日数据，以及异常事件的发生率（第一阶段）和压力水平（第二阶段）。第一阶段有1031名参与者（730名女性，平均年龄46.0岁），第二阶段有695名参与者（484名女性，平均年龄47.7岁）。采用面板数据回归分析来检验异常事件/压力与发作/症状之间的关联，包括对24小时超前和滞后效应的研究。
异常事件和较高的压力水平与梅尼埃病发作的几率较高及症状更严重相关。报告异常事件时发作的几率为2.94（95%置信区间[CI]2.37, 3.65），压力水平每增加一个单位，发作几率增加1.24（95%CI 1.20, 1.28）。随着压力增加，还发现压力对发作有24小时超前效应（比值比[OR]1.10[95%CI 1.07, 1.14]）和滞后效应（OR 1.10[95%CI 1.06, 1.13]）。
本研究提供了迄今为止最有力的证据，证明压力和异常事件与梅尼埃病的发作及症状加重相关。更好地理解压力和异常事件作为梅尼埃病的触发因素，可能会减少与这种疾病相关的不确定性，并改善患者的生活质量。
