**1. Introduction**

Ménière's disease is a complex multifactorial disorder of the inner ear, consisting of several concurrent symptoms (e.g. aural pressure, hearing loss, tinnitus and vertigo). Patients with Ménière's range from minimally symptomatic highly functional individuals to severely affected disabled patients. Each of the main triad of Ménière's symptoms can impact on quality of life. Tinnitus may be associated with sleep disturbance, depression, irritability, reduced concentration and auditory difficulties [1]. Hearing loss can result in communication difficulties, which can cause problems in work and social life. Vertigo is known to cause anxiety and restrict physical and social activities, therefore significantly impacting on patients' health and well-being [1]. Vertigo is often considered to be the most detrimental and debilitating symptom of Ménière's [2].

Research on the mental health and well-being impact of Ménière's disease is limited. Moreover, quantitative studies in this area are negatively influenced by small sample sizes (often with fewer than 500 participants), a lack of groups to compare the mental health impacts with (i.e. no control groups), and an inability to account for confounding factors. Furthermore, our understanding of how the mental health impact of Ménière's may shift over time is partial at best.

The patient perspective of what it is like to live with this disease within the context of their day-to-day life is critically important for developing appropriate healthcare pathways and ensuring that patients are able to lead as fulfilling lives as possible [3]. While some studies have considered the adverse impact of Ménière's on quality of life, along with patients' perspectives regarding triggers and symptoms of the disease [4], there is very limited information about how patients experience and manage the disease (or not), including its triggers and symptoms in everyday life. In addition, we are currently unaware of the role that other people may play in this process [5–7] or how these issues impact on the sense of mental health and well-being amongst people with Ménière's.

This chapter will build upon existing research in this area, describing a comprehensive, multilayered two-phase analysis of the impact of Ménière's on patients' mental health and wellbeing. First, epidemiological analysis from the most powerful Ménière's resource currently available (the UK Biobank, www.biobank.ac.uk) will provide insights on the mental health and well-being impacts of Ménière's at a population level (Phase I). Secondly, qualitative research (Phase II) will provide deeper insights into patients' experiences of living with and negotiating the triggers and symptoms of Ménière's disease on a day-to-day basis, including the role of significant others in this process.
