**Acknowledgements**

In day-to-day life, people with Ménière's can feel isolated, afraid, dependent and on some occasions embarrassed. Yet, reflecting previous literature on chronic illness [21], our research highlights the value of support networks and suggests they may enable people with Ménière's to live satisfying lives. We would, therefore, emphasise the importance of not just informing friends and family about the condition, but educating them on how they might best assist during its various manifestations. This might range from being mindful of inclusive forms of communication for those with impaired hearing, to supporting from afar during an attack. Aasbo et al.'s [28] concept of 'biographical we' is useful here in helping to understand the great effort partners of chronically ill put in to re-establish normality and continuity in everyday life; effort, that as our research signalled, can come at a cost of their own needs being overlooked. 'Ménière's is a disease that two people get' and this aspect warrants greater con-

Improvements in the frequency of depression episodes and health satisfaction were noted as disease duration increased. This may reflect the disease progression pathway, which usually involves a reduction in the number of vertigo attacks experienced by individuals as the disease progresses [29]. Our participants' improved ability to read their bodies and recognise signs of an impending attack suggests the development of *Ménière's literacy*. Borrowing from the concept of *interactive health literacy*, whereby individuals develop an improved capacity to act independently on knowledge with motivation and confidence in an empowered way [30], *Ménière's literacy supports* adaptation by individuals to their condition and/or medical interventions and lifestyle changes reducing the frequency of vertigo attacks. Given that vertigo is considered to be the most detrimental symptom in Ménière's [2], reductions in vertigo severity should, therefore, improve mental health and well-being. All of this is not to suggest that adaptation diminishes the ongoing sensory, emotional and social challenges that people with Ménière's face in their everyday life [16]. Indeed, our research showed that at a population level, disease duration did not alter the frequency of tiredness, tenseness or a lack of enthusiasm experienced by Ménière's sufferers. While some aspects of Ménière's may improve over time and an individual may adapt to some extent, overall it continues to impact negatively on

Our research findings emerged from cross-sectional data. It cannot and does not seek to determine the causal pathway of Ménière's disease. Our interpretations of the qualitative data are shaped as much by the absence of certain voices as they are by the presence of others. To that end, it is noteworthy that our sample for Phase II consisted primarily of women (16 female patients, 3 female supportive partners), with just four participants experiencing bilateral

Those limitations noted, the research provides the most comprehensive study of the mental health and well-being impacts of Ménière's to date and highlights the adverse mental health effects of Ménière's. By utilising the UK Biobank, the inclusion of key confounders and sufficient numbers to investigate the role of disease duration in Phase I has enabled us to offer a

symptoms of tinnitus, imbalance and hearing loss (i.e. symptoms in both ears).

sideration as part of the broader patient treatment pathway.

everyday life.

**5. Conclusions**

22 Up to Date on Meniere's Disease

The research presented in this book chapter was funded by the UK Ménière's Society. The Phase I research was conducted using the UK Biobank resource. We would like to thank participants from the UK Biobank and those that took part in the Phase II research.
