Meniere’s disease and CATS

catsAfter a short holiday break and a rerun of an article about BPPV, we return to the subject of Meniere’s disease (MD). We have discussed the problems associated with diagnosing and treating MD, but undoubtedly the most difficult aspect of MD is living with it. There is an old axiom regarding living with MD, and that is that people with MD should avoid CATS. Not the kind of cat that “meows” but rather Caffeine, Alcohol, Tobacco and Stress.

A couple of years ago, I posted a blog about the role of Caffeine in MD. A quick PubMed search revealed little concrete information about the roles of Alcohol and Tobacco, but I think it is worthwhile to explore the role stress plays in MD, and the role MD plays in the patient’s mental health.

While I can’t directly understand the impact MD has on a patient’s quality of life, I have seen enough MD patients over the years to see similarities in the way they describe that impact. Most will acknowledge that dealing with episodes of nausea, vomiting, vertigo, tinnitus and loss of hearing, for hours at a time, on a periodic basis, is pretty miserable. Nearly all of them will tell you that is not the worst part. The unpredictability of when the next episode is going to occur is the worst part. They live in fear of an episode happening in the middle of an important event, or when they are traveling alone, or on a day when the attention should be on someone else (like a family member getting married or graduating). So, it is easy to understand that living with MD can lead to an enormous amount of stress.

A more difficult task to accomplish is to determine if increased stress may actually lead to an MD attack. This is discussed in a recent article titled “The Influence of Psychological Factors in Meniere’s Disease” by FT Orji. The article is essentially a literature review of studies related to MD and stress, and anyone interested in more detail should follow the link to the article. Below I have pasted one short excerpt addressing the issue of increased stress causing an MD attack.

“Earlier studies have shown that the plasma levels of stress-related hormones such as antidiuretic hormones and catecholamines are elevated in conditions of endolymphatic hydrops including MD. These hormones were believed to alter the inner ear fluid dynamics, thereby producing auditory and vestibular dysfunction and the symptoms experienced in MD”

There is plenty of information to support the theory that stress leads to physiological changes in the body, and over time, those changes can be costly. It is likely that avoiding stress is good for MD patients, as well as pretty much everyone else on the planet. Good luck with that!

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.