Psychological characteristics of patients with Meniere's disease compared with patients with vertigo, tinnitus, or hearing loss

Ear, Nose & Throat Journal, March, 2007 by Marina Savastano, Gino Marioni, Maria Aita

Abstract

An association between Meniere's disease and psychological distress is frequently reported. Patients who do not have Meniere's disease but who have similar symptoms also experience various kinds of psychological disturbances. We conducted a study to investigate the relationship between Meniere's disease and personality traits, illness behavior, depression, and anxiety. We compared these factors in 77 patients who had Meniere's disease and 133 controls who did not have the disease but had one of its symptoms--either vertigo, tinnitus, or hearing loss. The mental status of study participants was assessed with standard tests. Patients in both groups had higher than normal levels of anxiety and neuroticism. The only significant difference between the two groups was a higher rate of extroversion in the Meniere's disease group. Minor differences emerged when Meniere's patients with tinnitus or vertigo were compared with similar controls. Relationships between psychological observations and otologic symptomatology or an otologic diagnosis were not specific, which illustrates the need to consider the role of illness behavior and personality as targets for psychological support or therapy associated with ENT treatment.

Introduction

Many symptoms typical of some otologic diseases--such as vertigo, tinnitus, and heating loss--are accompanied by psychological disturbances. Symptoms may be present simultaneously, as is the case with Meniere's disease, or alone.

Meniere's disease is generally associated with great psychological distress. Some authors contend that this distress occurs secondary to the disease; other authors believe that the disease itself is actually psychosomatic in origin. (1-5) The psychological distress may manifest as emotional instability, high levels of neuroticism, low levels of extroversion, a tendency toward social disadaptation, and a predisposition to anxiety and depression or a depressive state.

Associations have been noted between Meniere's disease and nervous and meticulous behavior and between Meniere's disease and marital status. A relationship has also been observed between vertigo attacks and distressing factors in Meniere's disease patients, but the relationship appears to be subjective. Approximately 75% of patients with Meniere's disease report that their symptoms limit certain aspects of their life, but the relationship between their discomfort and life satisfaction is only moderate. (6,7)

Some authors believe that there is a genetic predisposition to Meniere's disease. (8-10) In the 1990s, our group conducted a study of 50 Meniere's disease patients to evaluate their personality traits, illness behavior, depression, and anxiety. (11) We found that these patients had significantly higher than normal mean scores for neuroticism and psychological perception of disease. On the other hand, these patients had low scores for affective inhibition (even without great psychological distress, as confirmed by high scores for depression, anxiety, neuroticism, hypochondriasis, disease conviction, dysphoria, and irritability) and low scores for denial. We interpreted these findings as partly representing a result of predisposition factors (e.g., anxiety traits and neuroticism) and partly as representing a sequela of Meniere's disease and indicative of abnormal illness behavior.

Vertigo is probably the symptom that is most frequently associated with psychological disturbances. In the "anxiety neurosis" description of classic psychopathology, the relationship between anxiety and vertigo has already been recognized. In the psychodynamic interpretation, vertigo in particular is considered to be associated with separation anxiety, of which it seems to be a somatic expression.

Some reviews of the link between panic disturbances and vestibular symptoms have been published. (12,13) The greater prevalence of psychiatric disorders in vertiginous patients who have no evidence of otologic changes may mean that psychiatric symptomatology is not simply a reaction to vertigo. Some authors also support the hypothesis that panic disorder is often associated with functional vestibular pathology. (14,15) The link between anxiety disturbances and vertigo is generally interpreted as an effect of somatopsychic and psychosomatic processes, one of which may be sensitization at the cerebral level. (16) Besides anxiety, phobia, and panic attacks (with or without agoraphobia), vertigo is accompanied by depression, dysthymia, and alteration in the quality of life. (17-19)

It has been observed that tinnitus more frequently affects patients with somatic and hypochondrial disturbances than general medical outpatients, indicating that unexplained tinnitus may be a symptom of somatization. Tinnitus sufferers often present with depression, irritability, tension, and sleeping disturbances that modify their quality of life. Some subjects seem to be able to cope positively with the symptom, but others respond negatively. (20,21)

These observations led us to study illness behavior in association with personality traits, anxiety, and depression in such patients, and we published a report in 1996. (11) We found that tinnitus patients had a high state anxiety level along with introversion, neurotic tendency, affective inhibition, and high denial. Cluster analysis identified two subgroups of patients. One subgroup responded normally to psychological tests except for high denial, and the other had high scores for anxiety and depression accompanied by introversion, neuroticism, and illness behavior alterations with high degrees of hypochondriasis and disease conviction, dysphoria, and irritability. The second subgroup was also more often affected by high-intensity tinnitus and, before or after its onset, by psychological symptoms and/or functional somatic symptoms. The second subgroup also made more frequent use of psychotropic drugs. These data are compatible with the hypothesis of a somatopsychic and psychosomatic vicious circle.