Frequency and severity of anxiety in patients with Meniere's disease: a systematic review and meta-analysis.

BACKGROUND: Ménière's disease (MD) is a chronic, progressive disorder of the inner ear, which is currently incurable. Anxiety is a known exacerbating factor for vertigo episodes in these patients; however, its precise frequency and levels in this population remain undefined. OBJECTIVE: The purpose of this study is to synthesize the available evidence related to the frequency and levels of anxiety in patients with MD. DESIGN: A systematic review and meta-analysis reported according to PRISMA and MOOSE guidelines. PARTICIPANTS: Observational studies, published until May 2023, reporting the frequency and/or severity of anxiety in patients with MD were included, with no restrictions by country or publication date. MAIN OUTCOME MEASURES: PubMed, Embase, Scopus, LILACS, Web of Science, and PsycINFO were systematically searched to identify relevant articles. Two independent reviewers selected studies, extracted data, and assessed the methodological quality of the included studies. Because the included studies used different anxiety instruments, exploratory meta-analyses were restricted to studies using the Beck Anxiety Inventory (BAI), which provided comparable data on anxiety severity categories and mean scores. RESULTS: Eight studies involving 283 patients were selected. Three contributed to the BAI-based meta-analyses. The pooled prevalence of moderate-to-severe anxiety, as assessed by the BAI scale, was 68% (95% CI: 43-75%; I2 = 56.3%; 2 studies; n = 99). The pooled mean BAI score was 23.26 points (95% CI: 19.31-27.21; I2 = 53.8%, 2 studies; n = 88), which falls within the moderate anxiety range according to BAI cut-off points. Most studies had good methodological quality. CONCLUSIONS: Based on the limited BAI-based evidence available, moderate-to-severe anxiety appears to be frequent among patients with MD, and the pooled mean BAI score suggests moderate anxiety severity. RELEVANCE: Major MD management guidelines have not addressed this issue. Psychological and/or pharmacological anxiety treatment should be considered an essential component of its management. Record: CRD42023431494 (PROSPERO).