A Two-Year Randomized Trial of Interventions to Decrease Stress Hormone Vasopressin Production in Patients with Meniere's Disease-A Pilot Study.

Tadashi Kitahara,Taeko Ito,Hidehiko Okamoto,Munehisa Fukushima,Toshiaki Yamanaka,Akinori Yamashita,Ichiro Ota,Masaharu Sakagami,Russell R Lonser

doi:10.1371/journal.pone.0158309

Tadashi Kitahara, Taeko Ito + Show 7 more

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https://doi.org/10.1371/journal.pone.0158309

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Abstract

Meniere's disease, a common inner ear condition, has an incidence of 15–50 per 100,000. Because mental/physical stress and subsequent increase in the stress hormone vasopressin supposedly trigger Meniere's disease, we set a pilot study to seek new therapeutic interventions, namely management of vasopressin secretion, to treat this disease. We enrolled 297 definite Meniere's patients from 2010 to 2012 in a randomized-controlled and open-label trial, assigning Group-I (control) traditional oral medication, Group-II abundant water intake, Group-III tympanic ventilation tubes and Group-IV sleeping in darkness. Two hundred sixty-three patients completed the planned 2-year-follow-up, which included assessment of vertigo, hearing, plasma vasopressin concentrations and changes in stress/psychological factors. At 2 years, vertigo was completely controlled in 54.3% of patients in Group-I, 81.4% in Group-II, 84.1% in Group-III, and 80.0% in Group-IV (statistically I < II = III = IV). Hearing was improved in 7.1% of patients in Group-I, 35.7% in Group-II, 34.9% in Group-III, and 31.7% in Group-IV (statistically I < II = III = IV). Plasma vasopressin concentrations decreased more in Groups-II, -III, and -IV than in Groups-I (statistically I < II = III = IV), although patients’ stress/psychological factors had not changed. Physicians have focused on stress management for Meniere’s disease. However, avoidance of stress is unrealistic for patients who live in demanding social environments. Our findings in this pilot study suggest that interventions to decrease vasopressin secretion by abundant water intake, tympanic ventilation tubes and sleeping in darkness is feasible in treating Meniere’s disease, even though these therapies did not alter reported mental/physical stress levels.Trial Registration: ClinicalTrials.gov NCT01099046

Highlights

Meniere's disease, characterized by recurrent vertigo, fluctuating hearing loss and persistent tinnitus, is a common disease with an incidence of 15–50 per 100,000 [1]
Vertigo control and hearing improvement according to the criteria of the 1995 Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) [10] during the 2 years of follow-up are shown in Fig 2 and Fig 3
During the same period, hearing in G-II improved in 35.7% and worsened in 11.4%, in G-III improved in 34.9% and worsened in 12.7%, and in G-IV improved in 31.7% and worsened in 13.3%

Summary

Introduction

Meniere's disease, characterized by recurrent vertigo, fluctuating hearing loss and persistent tinnitus, is a common disease with an incidence of 15–50 per 100,000 [1]. It has been reported that Meniere's disease is usually triggered by various kinds of stimuli, i.e. genetic, infectious, vascular, dietary, allergic, autonomic, endocrine, autoimmune, or other insults to the inner ear, associated with a small misplaced malfunctioning endolymphatic sac [2]. In spite of these undetermined insults, so many ENT doctors have had an impression of strong relationships between stress and Meniere's disease. Several studies have reported psychological and cognitive therapies for Meniere’s disease [3] Many physicians advise their patients to take adequate time out for stress management. It is difficult, often unrealistic, for most of Meniere’s patients to undertake long-term psychological treatment and/or change their work situation to reduce stress in their daily life

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