Stress as a Trigger of Attacks in Menière's Disease. A Case‐Crossover Study

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Abstract
Background: Menière's disease is defined as the presence of recurrent, spontaneous episodic vertigo, hearing loss (HL), aural fullness, and tinnitus. The occurrence of attacks is unpredictable. The etiology is still unknown, but the disease has a pathologic correlate in hydropic distension of the endolymphatic system. Earlier studies have shown increased incidence of stress on the same day as vertigo attacks, but it has not been determined whether stress occurring on the day of the vertiginous episode came before or after the onset of the vertigo.Methods: A case‐crossover study including 46 patients with active Menière's disease.Main Outcome Measure: Relative risks with 95% confidence intervals (CI).Findings: During the study period, 153 Menière's attacks were reported. Twenty‐four (52%) of the 46 patients reported attacks. Twelve of the 153 (8%) attacks occurred within 3 hours after exposure to emotional stress. The relative risk of having an attack was 5.10 (95% CI 2.37–10.98) during 3 hours after being exposed to emotional stress. Twenty‐nine percent of the patients with attacks had at least one attack after exposure to emotional stress. For mental stress, the relative risk was 4.16 (95% CI 1.46–11.83) and the hazard period 1 hour, but only five attacks were exposed. No excess risk was found after physical stress.Interpretation: Being exposed to emotional stress increases the risk of getting an attack of Menière's disease during the next hour, and the hazard period is possibly extended up to 3 hours.