Pulsatile Tinnitus.

What Is Pulsatile Tinnitus?

To understand Pulsatile Tinnitus, one must first understand what exactly tinnitus means. Tinnitus is the name given to a condition in which an individual hears a sound in the ear, usually ringing or whistling sound, without any source for the sound. Sometimes, the sound could resemble that of twittering of birds or that of your heart beating. This sound may come and go but when it is present it tends to be pretty annoying and distracting. Now coming to Pulsatile Tinnitus, it is a form of tinnitus in which the affected individual hears a rhythmical sound resembling that of a heartbeat. This form of tinnitus can be identified easily than the other forms of tinnitus and the same is true for the cause of it. Affected individual may experience pulsatile tinnitus or beating sound of the heart in both ears or in some cases only one ear. They may experience beating sound of the heart in the ear this while lying down or sleeping on one side.



What Can Cause Pulsatile Tinnitus Or Heartbeat Sound In Ears?

Pulsatile Tinnitus or heartbeat sound in ears is usually caused due to an apparent change in blood flow to the vessels which are present near the ears. Some of the vessels which may cause a Pulsatile Tinnitus are the large arteries and veins in the neck and base of skull and the smaller vessels in the ear itself. This alteration in blood flow can be due to the following factors:

Generalized Increased Blood Flow: It is observed that blood that flows faster tends to make more noise than blood that tends to flow a bit slowly. The rate of the flow of blood can increase due to many causes like heavy strenuous activities or during pregnancy. Blood flow can also increase in individuals who have medical conditions like anemia or an overactive thyroid.

Localized Increased Blood Flow: At times, the blood flow is faster only in a single vessel instead of in a generalized fashion. This can be explained by citing an example in which during development of a fetus there is an artery in the middle ear called the stapedial artery which closes as the pregnancy progresses but in some cases this does not happen and in such cases flow of blood adjacent to the ear structures can result in Pulsatile Tinnitus. Another cause of Pulsatile Tinnitus can be benign tumors of the head and neck.

Turbulent Blood Flow Causing Pulsatile Tinnitus: This happens when the inner part of the blood vessels become irregular thus causing turbulence during blood flow which results in production of a sound causing Pulsatile Tinnitus. The vessels usually become irregular because of a condition called atherosclerosis in which the arteries become hard.

Altered Awareness: In case if an individual has conditions like a perforated eardrum, then that individual will tend to hear more sounds from inside of the body since the external hearing becomes impaired. Also increased sensitivity in the auditory pathway tends to alert the brain to the sounds of the blood vessels.

Other Causes of Pulsatile Tinnitus: There are some other causes of Pulsatile Tinnitus or heartbeat sound in ears as well like there is a medical condition called idiopathic intracranial hypertension in which there are frequent headaches and visual impairment along with Pulsatile Tinnitus. This condition is found usually in overweight individuals. The root cause of this condition still remains unknown.

How Is Pulsatile Tinnitus Diagnosed?

In order to diagnose Pulsatile Tinnitus, the treating physician will begin by taking a history of the individual as to the duration of these sensations. The physician will also inquire about any other medical conditions that the individual may have. The next thing will be to conduct a detailed physical examination examining particularly the ears and the neck. The physician may use a stethoscope to listen to any sounds emanating from the ear or the neck. Post this, a hearing test will be performed to look for any abnormalities in the individual’s hearing capability. The physician may also order some imaging studies in the form of ultrasound to look at the blood flow within the vessels of the neck. An MRI of the head and neck may also be performed to better look at the internal structures of the neck and also the ears to look for any sort of abnormalities. Apart from this, an MRA may also be performed to look at the veins and arteries to look for any sort of irregularities or hardening of the arteries causing Pulsatile Tinnitus. A CT Angiogram may also be done for this purpose. Some of the other studies that may be done to investigate the cause of Pulsatile Tinnitus are Blood tests to rule out conditions like anemia or hyperthyroidism, which are quite common causes of Pulsatile Tinnitus. In case if an idiopathic intracranial hypertension is suspected by the physician, then the individual may need referral to other specialists such as ophthalmologists or neurologists who may then investigate this further with their own set of investigative studies.

What Are Treatments For Pulsatile Tinnitus?

The treatment for Pulsatile Tinnitus or heartbeat sound in ears is based on the underlying cause for the condition. In case if Pulsatile Tinnitus is caused due to anemia then regular blood transfusions and medications directed towards treatment of anemia is good enough to treat the Pulsatile Tinnitus. In case of overactive thyroid causing this condition then treatment for that can treat the Pulsatile Tinnitus. If the tinnitus is caused due to a perforated eardrum then these perforations need to be closed by utilizing grafts. If turbulent blood flow due to hardening of the arteries is suspected for causing Pulsatile Tinnitus then repair of these narrowed and hardened arteries is required so that blood flow becomes smooth again and the Pulsatile Tinnitus is cured. In some instances, despite knowing the cause, treatment may not cure the tinnitus like in the case of a specific blood vessel causing Pulsatile Tinnitus which cannot be repaired just because of the location of the vessel. In some instances where there is no identifiable cause for the Pulsatile Tinnitus then the following therapies might be useful in controlling the tinnitus: Sound Therapy, relaxation techniques, cognitive behavioral therapy, psychological counseling, meditation, yoga and in some cases Tinnitus Retraining Therapy which has been found to be helpful for controlling symptoms caused by Pulsatile Tinnitus.

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Maya Angelou’s 3 best lessons about coping.

The 3 Lessons Maya Angelou Taught Us About Coping

Posted: Updated:

By Jan Bruce

When poet, memoirist, screenwriter, film director, jazz singer, dancer, professor, and civil rights activist Maya Angelou died in May at the age of 86, I reflected on two thoughts. The first was, Is there anything this woman couldn’t do?

And the second thing I realized, as social and traditional media overflowed with tributes and expressions of gratitude for her life and work, was this: Maya Angelou helped people feel like they were possible of living great, meaningful lives.

She became, for so many, a symbol of resilience — the capacity to persist in the face of hardship and adversity — and beyond that a symbol of boundless creativity. She didn’t just survive the significant trauma of her early life; she made something magnificent of that life. (Read more about the power of resilience.)

Her many works of art and scholarship are part of her widely recognized greatness, but I think the “magnificent” part is related to my second thought: creating meaningful lives. Her creativity wasn’t about how much better she was than everyone else; it was inclusive. It was grounded in a belief that we ought to help each other sing if we have a song — and that everyone has a song.

In my work helping people develop the skills they need to become more resilient to the stressors and pressures of their lives, be they large or small, I have come to know, beyond a doubt, that resilience, creativity, and generosity are key qualities in coping with stress and crafting a meaningful life. These three quotes speak to Dr. Angelou’s deep understanding of these qualities.

“You may not control all the events that happen to you, but you can decide not to be reduced by them.” — Maya Angelou

Dr. Angelou’s childhood was unpredictable — many moves and many homes — and included a period of devastating violence that left her mute for almost five years. Even after she recovered, her life remained tumultuous, both in her personal choices (working as the first black streetcar conductor at age 16) and the the world around her, as when the assassinations of her friends and colleagues Malcolm X and Martin Luther King, Jr., devastated her. And yet, Angelou persisted; as she wrote in what is perhaps her most famous poem, “Still I Rise.” These events shaped her but they didn’t define or stop her. Read more on the essence of resilience.

“My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style.” — Maya Angelou

Resilience doesn’t have to stop at making it through the day-to-day grind with a little less trouble. Once you free up mental and physical energy, the question is this: What wonderful thing are you going to do with it?

Angelou was drawn to the arts in almost any form — classical music, fine art, drama, dance, poetry. That was her wonderful thing. But thriving isn’t exclusive to painting or poetry, of course. It’s whatever you are driven to be and do. What Angelou modeled was a complete commitment to the expression of her wonderfulness. She showed what it looked like to thrive on a grand scale.

“You can see in others what they don’t see in themselves and what the world doesn’t see in them. We all have that possibility, that potential and that promise of seeing beyond the seeming.” — Maya Angelou

Angelou wrote for her own creative satisfaction, but she was driven by the desire to encourage and inspire people beyond their limitations, whether they were self-imposed, determined by society, or handed down through history. The point of endeavor was, as she wrote, “to be a rainbow in someone else’s cloud.” She sought to be that rainbow for anyone who could read or hear her work.

As Andrew Shatte, Ph.D., one of meQuilibrium‘s co-founders, has discovered in his research, those who feel connected to something larger than themselves, their family, or immediate community are operating at the highest level of achievement. And that higher, generous purpose gives you the power both to withstand anything and to do the hard, worthy work of living a meaningful life.

One last quote from Maya Angelou captures these three qualities of resilience, creativity and generosity, and a zest for life that kept her young, and will keep you young, too:

“The most important thing I can tell you about aging is this: If you really feel that you want to have an off-the-shoulder blouse and some big beads and thong sandals and a dirndl skirt and a magnolia in your hair, do it. Even if you’re wrinkled.”

Jan Bruce is CEO and co-founder of meQuilibrium, the new digital coaching

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The Influence of Psychological Factors in Meniere’s Disease


Meniere’s disease (MD) is an inner ear disorder, characterized by stressful disabling symptoms complex of spontaneous episodic vertigo, sensorineural hearing loss, tinnitus and aural fullness.[1,2,3] The disease is chronic and its etiology is still unknown. However, the endolymphatic hydrops is the most common pathophysiologic correlate.[4,5] A number of otolaryngologists have long accepted the notion that patients with MD are subject to anxiety and tension states and that this stress can aggravate the symptoms already present. They have observed that psychological factors play a more important role in the causation and the course of MD, as well as its impact on the quality of life (QOL) of sufferers than is commonly realized.[5,6,7,8] In a large number of MD patients, the first set of attacks of vertigo and later tinnitus and deafness have been observed to follow definite underlying life stressful intolerable situation with an explosive outburst of backing up of tension. Such life stresses have been reported as death of near relatives, conflicts cantered around sexuality, abnormal avoidance of sex relationships especially among males, situations of antagonism to some individual or group important to the patient’s welfare and various other life stresses.[6] In view of these observations, MD has received a lot of research attention from a psychological point of view. Researchers have earlier evaluated the psychosomatic theory of the disease in which they recognize that the symptoms of MD have an organic basis, but its causes were sought in psychosocial stressors and the inability of the patient to cope with stress.[5,6,7,9] On the other hand, somatopsychic theory of the disease has also been explored in which psychological disturbances associated with MD are believed to be the consequences of the disease process rather than the cause of the disease.

Whether the disease or the psychological condition comes before the other, remains unresolved and is probably not as important as understanding how the emotional and physical factors interact in MD. In other words, are there indications that interactions of certain specific emotional stressful situations, acting on a predisposing personality structure, play a role in producing the disease? In this review, an overview of the concept of interaction between the somatic factors in MD and its psychological aspects as it affects the disease’s impact on the daily life of sufferers is presented.

Materials and Methods

A wide literature search of PubMed, African Journals Online, Health Internetwork Access to Research Initiative and ovid with no date restriction was conducted with the keyword MD. The search engines returned 7047 related articles on MD. Further filtration yielded 73 articles on “psychological factors and QOL.” Extracted materials spanned between 1970 and 2010. Data from the studies were extracted and assessed for inclusion. A total of 33 studies were identified and thoroughly read. All 26 articles were prospective cohort cross-sectional studies, while two of the studies were retrospective review of Meniere’s patient treated in a tertiary institution. Four of the studies were systematic literature review articles.

Interaction between psychological and somatic factors in MD

In a study that reviewed the psychological aspect of MD, Van Cruijsen et al.[8] conducted a chronological review of studies concerning the psychosomatic and somatopsychic hypotheses in MD and the combined hypotheses. They held a position that psychosomatic factors do not represent the exclusive etiologic cause of MD and that even when a somatopsychic factor seems to be present, it also does not provide the sole explanation. They suggested that the process may constitute a vicious circle: Symptoms of the disease may worsen the emotional state, which in turn may worsen the symptom perception. The authors concluded that a continuous interaction between psychological, somatic and environmental factors would be considered in interpreting this complex process.

Similarly, other studies have evaluated the interaction between psychological stress, behavioral characteristics and symptoms of MD and concluded that they produce a vicious circle.[13,19,20] In one of the studies, a questionnaire was devised to analyze life-style and behavioral characteristics in 60 MD patients compared with 936 healthy controls. The MD patients were shown to have a significantly greater stress-causative tendency in behavioral characteristics, felt stronger anxiety and presented more severe symptoms incidental to this anxiety compared to the controls. The behavioral characteristics of escape were found to be psychosomatically very harmful. It was suggested that the behavioral characteristics in MD patients, being more stress-causative than in normal controls, may play a role in the genesis of endolymphatic hydrops, possibly through stress-related hormones.[20] Earlier studies have shown that the plasma levels of stress-related hormones such as antidiuretic hormones and catecholamines are elevated in conditions of endolymphatic hydrops including MD. These hormones were believed to alter the inner ear fluid dynamics, thereby producing auditory and vestibular dysfunction and the symptoms experienced in MD.[21,22,23]

More recently, Van Cruijsen et al.[5] in 2006 conducted a psychological assessment of 110 MD patients and 26 controls suffering from other chronic illnesses such as acoustic neurinoma, otosclerosis, neuritis vestibularis, ototoxicity, benign paroxysmal positional dysfunction, migraine, hereditary hearing loss and partial epilepsy. They aimed to evaluate how psychological, physical and environmental factors in MD interact and why one patient develops more frequent and severe problems after getting MD than others. The authors utilized multiple validated questionnaire instruments, which included: The “daily hassles list,” which quantifies the frequency and intensity of problems in different circumstances, “coping inventory,” which was designed to assess coping with stressful situations, the five personality domains of: Neuroticism, extraversion, openness (NEO) to experience, altruism and conscientiousness were assessed with the “NEO five factor inventory,” the “symptoms checklist” was designed to measure physical and psychological complaints, the “general health questionnaire” was designed to screen for minor psychiatric disorders in the general population and the “medical outcome short form health survey” which assessed well-being and functional status (QOL). The authors found that Meniere’s patients experienced more daily hassles as well as more psychological and physical problems compared with the normative values and were less task-oriented in their way of coping with stressful situations. Their results indicated that 63% of the Meniere’s patients showed psychopathology such as anxiety and depression. In considering the duration of the illness, the patients who were longer affected by the disease had significantly more daily stressors, worse physical and social functioning and more bodily pain. However, when authors compared the psychometric results of the Meniere’s patients and the results of the control (patients with other audio-vestibular diseases), they found no significant difference in any of the psychological test results and then suggested that the psychopathology seems to be the result of having a chronic disease.

Similar studies compared the psychological characteristics of Meniere’s patients who had been diagnosed as such by otologists with two groups of non-Meniere’s patients: Those with otologic disorders who did not have vertigo and those patients with diverse otologic disorders but who had in common vertigo as a symptom. When MD patients were compared with non-vertiginous patients, the psychological profile of the Meniere’s patients put them clearly as emotionally damaged. However, when the Meniere’s group was compared with the non-Meniere’s vertiginous group, the difference was found to be washed out and the groups were very much alike psychologically. It was reasoned that since the non-Meniere’s vertigo group had, in large measure, identifiable organic disease, the similar psychological picture that emerged when compared with the Meniere’s group, was understandably believed to be the response to the disease rather than its cause. Authors concluded that the culprit responsible for the psychological picture observed MD seem to be vertigo and added that any illness that has a symptom as disabling as vertigo can produce its own form of psychopathology.[11,16]

The results regarding personality aspects in MD remained contradictory. Sawada et al.[23] did classify the personality structure of MD in the normal range. Similarly, Van Cruijsen et al.[5] found no abnormal personality traits in Meniere’s patients compared with the values of their controls. On the contrary, Groen[7] documented that MD patients exhibit a specific personality structure, characterized by high intelligence, great diligence and a strong sense of duty. Savastano et al.[18] described MD patients as obsessive-compulsive persons, perfectionists and neurotics, who are supposed to be more vulnerable and have more stress exposure. In a study that examined the psychological profile of MD, Meniere’s patients were reported to exhibit anxious and depressive personality.[24] In a study in which questionnaires were devised to analyze the life-style and behavioral characteristics of MD patients and a large control population, Takahashi et al.[20] documented that patients with MD had nervous and scrupulous personalities and possessed more stress-causative tendencies in behavioral characteristics compared with the control group. De Valck et al.[25] found a type-D personality is more prevalent in 29 MD patients compared to 59 other patients with a peripheral vestibular disorder experiencing vertigo. They also documented that, subjects with a type-D personality feel more handicapped due to their vertigo symptoms than non-type-D subjects. Similarly, it was hypothesize in two separate studies that patients with psychological distress might perceive a stronger rotational vertigo and unsteadiness than patients in a normal mood.[26,27]

QOL perception in MD

Ordinarily, people encounter many episodes that may be physically and psychologically causative of stress in their day to day experiences. Even such episodes that are seemingly similar may give different impacts on different people, since their individual behaviors and sensitivities to stress may differ. In MD which is a chronic condition, a patient’s life will understandably change considerably, especially in view of its tendency to involve the contralateral ear in the course of time and the fact that the course of hearing loss is not altered by any form of treatment.[28,29] The concept “QOL” has been defined as the individual’s perception of his/her position in life in the context of the culture and value system in which they live and in relation to their goals. Thus, QOL has been analyzed in three separate domains: Physical; psychological; and environmental. The physical component refers to the physical effects of the disease, i.e. pain, fatigue or vertigo, while the psychological domain has been related to an individual’s mood in a global sense, e.g. fear or depression. The environmental domain has been evaluated from two different perspectives: Social participation and role activities.[8,14,15,25,29,30,31]

Anderson and Harris[14] evaluated the impact of MD on the QOL using several general outcome instruments. These included the quality of well-being scale (measured a point-in-time expression of wellness and specifically, the daily effects of many symptoms related to MD in terms of functional status), the medical outcomes study SF-12 (measured both physical and mental scores) and the Center for Epidemiologic Studies-depression scale (produced a measure of psychologic depression). Their quality of well-being scale results indicated that patients with MD are severely incapacitated by their illness and in acute episodes; MD seems to be one of the most debilitating diseases compared with people who survive other debilitating illnesses. The mean Center for Epidemiologic Studies-depression scale score of patients with MD was comparatively worse than the scores of patients who were hospitalized for trauma, who were shown to be depressed as a result of serious injury as well as patients with cochlear implants. They concluded that all outcome instruments indicated that MD is serious in its physical and mental health consequences on the sufferers and that the days with acute episodes of MD symptoms are significantly worse than the days without such symptoms.

Van Cruijsen et al.[5] documented poorer QOL scores among the 110 Meniere’s patients compared with normative values, with their patients showing more limitations due to their restricted physical functioning as well as showed a worse general health perception and poorer social functioning with less vitality. Authors also found that the QOL was significantly worse in patients with more severe symptoms. They however reported coping strategies and the frequency of daily stressors to be the same in the low and high severity symptom group. It was suggested that the severity of the symptoms has more effect on the QOL, than coping or daily stressors in MD.

Kinney et al.[29] investigated the long term effect of MD on hearing and QOL in 51 selected Meniere’s patients who were at least 1 year post treatment using validated disease specific QOL measure questionnaire designed to quantify the hearing loss, tinnitus and dizziness handicap. These included “hearing handicap inventory for adults” designed to evaluate the emotional and social consequences of hearing impairment; the “dizziness handicap inventory” assessed the functional, emotional and physical consequence of dizziness; the “tinnitus handicap inventory”; and the “SF-36 health survey,” which assessed physical functioning, role limitations, social functioning, bodily pain, general mental and general health perception. They found that the emotional aspect of MD was more handicapping than the physical components. Authors concluded that patients with MD have more emotional disability than physical disability.

The influence of vertigo, hearing impairment and tinnitus on the daily life of Meniere’s and non-Meniere’s patients has also been studied. Söderman et al.[31] found that MD patients experience a bad QOL and they indicated that vertigo is the most influencing factor on the major implications of this disease on their daily lives.

Cohen et al.[15] investigated the influence of these symptoms on the QOL of 51 MD patients who filled in a self-administered questionnaire designed to investigate the physical, psychological and environmental domains of the QOL. The authors found that vertigo is the most bothersome symptom influencing a subject’s performance at work, followed by hearing loss. This however contrasts with the results of a study designed to investigate the influence of vertigo, hearing impairment and tinnitus on the daily life of 514 MD patients in which the subjects reported most discomfort from tinnitus. However, the results also showed that these 3 major symptoms had a strong negative effect on the daily life of MD patients, with 75% of the subjects avoiding certain everyday activities or situations because of the disease. More than half of the subjects were reported to have stated that they never felt free of discomfort from the illness, even though 36% gave examples of situations in which they felt free of the discomforts of the symptoms of MD such as: Being on holiday, being in the country-side, being at home alone, being on diets, when flying and when doing spots activities.[32]

The impacts of vertigo attacks on the QOL of non-Meniere’s vertiginous patient and in comparison with Meniere’s patients have also been evaluated. Bamiou et al.[33] documented higher disability and handicap score among patients with a unilateral vestibular disorder after excluding MD, than the normative values. In a study that compared the level of psychological distress and disability in groups of patients with vertigo, the researchers reported that patients with only vertigo experience the same level of anxiety, depression and somatic complaints compared with Meniere’s patients. It was concluded that vertigo impacts negatively on the QOL of sufferers regardless of the pathology[17] De Valck et al.[25] evaluated the level of handicap exhibited by 5 pathological groups of 88 vertigo patients which included 29 Meniere’s patients, using the “Dizziness Handicap Inventory.” The non-Meniere’s groups that were also evaluated include: Benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (23), vestibular neuritis (8), vestibular schwannoma (20) and post-traumatic non-BPPV vertigo (8). They reported high handicap score in all the 5 groups, even though those with type-D personality had higher scores.

Thus, in MD the frightening attacks of vertigo seem likely to produce and increase the level of anxiety thereby worsening the emotional state and the resultant anxiety provokes various symptoms probably through disorders of the autonomic nervous system occasioned by the increased levels of stress-related hormones. Hence, a vicious circle of interaction between somatic organic symptoms of MD and resultant psychological stress develops. Understandably, those with predisposing psychological personality characteristics are more likely to suffer more impact of this vicious cycle on their QOL than Meniere’s patients whose personalities are in the normal range.


In MD, there seem to exist a vicious circle of interaction between the somatic symptoms especially vertigo and resultant emotional disturbances, which in turn tend to provoke some other somatic symptoms. The QOL of the sufferers is severely incapacitated by the illness, especially the psychological well-being, which manifest mainly with anxiety and depression, dominating the physical and environmental disturbances. Worse QOL tends to occur in Meniere’s patients with more severe vertigo symptom.

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Gut microbes trigger autoimmune disease.

Gut microbes trigger autoimmune disease later in life in mice

Public Release: 19-Jan-2015HEIDELBERG, 19 January 2015 – Researchers have revealed that the colonization of the gut of young mice by certain types of bacteria can lead to immune responses later in life that are linked to disease. Increases in the levels of segmented filamentous bacteria can trigger changes in the lymphoid tissue of the mouse gut that result in the production of antibodies that attack components of the cell nucleus. This type of damage is a hallmark of autoimmune diseases like systemic lupus erythematosus and systemic sclerosis where organs throughout the body are damaged by wayward immune responses. The findings are published in The EMBO Journal.

“Our results demonstrate how gut health in young animals may be linked to autoimmune disease in older animals,” says Dirk Elewaut, Professor at Ghent University Hospital in Belgium and VIB Inflammation Research Center, Ghent University, Ghent, Belgium who is one of the lead authors of the study. “The microbiome of the young mouse impacts a loss of tolerance of the secondary immune system against proteins in the nucleus of the cell. The attack of certain proteins by the body’s own immune system can subsequently lead to tissue damage and disease.”

The researchers used mice in which secondary lymphoid organs were lacking for their studies. Secondary lymphoid organs include lymph nodes, tonsils, spleen and other structures where lymphocytes, the white blood cells that play essential roles in the body’s immune system, are activated. The mice were produced by interfering with lymphotoxin and Hox11, two essential proteins involved in the autoimmune response of animals. The scientists showed that approximately one quarter of mice modified in this way spontaneously developed antibodies that would attack components of the cell nucleus. This increase in undesired, self-inflicted immune reactions was influenced by the presence of segmented filamentous bacteria in the gut of younger mice. Segmented filamentous bacteria are clostridia-related microorganisms found in the gut of many animals including mice, rats and humans.

“We have demonstrated a link between the microbiome of young mice and the later onset of autoimmune disease,” says Elewaut. “Further work is needed to establish the precise molecular mechanisms that leads to the onset of diseases like systemic lupus erythematosus and systemic sclerosis in humans but we now have a new path of enquiry that we can pursue and look for potential interventions.”

Commensal microbiota influence systemic autoimmune responses

Jens T. Van Praet, Erin Donovan, Inge Vanassche, Michael B. Drennan, Fien Windels, Amélie Dendooven, Liesbeth Allais, Claude A. Cuvelier, Fons van de Loo, Paula S. Norris, Andrey A. Kuglov, Sergei A. Nedospasov, Sylvie Rabot, Raul Tito, Jeroen Raes, Valerie Gaboriau-Routhiau,Nadine Cerf-Bensussan, Tom Van de Wiele, Gérard Eberl, Carl F. Ware and Dirk Elewaut

Read the paper:

The paper will be available at 12:00 noon on Monday 19th January

doi: 10.15252/embj.201489966


If you would like to receive a PDF of the paper during the embargo period please send an email to barry.whyte@embo.org

Further information on The EMBO Journal is available at emboj.embopress.org

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A mans story of Menieres disease!

I can remember the exact instant when everything changed.

It’s seared into my brain like a photograph.

My doctor was supposed to help me. He was going to explain the vertigo and make it stop. It’s his job after all. You get sick and the doctor helps you get better. How could I have known?

Meniere’s disease.

My doctor spoke the words and in the blink of an eye, a terrible potential was made real. The problem wasn’t going to go away. The problem was permanent, and for a long time everything seemed impossible.

Meniere’s disease demanded so much of me. I missed so many opportunities, as if saying no would keep me safe.

But more often than not it was fear, not Meniere’s disease that held me back, and it took me a long time to understand that I often suffered more from regret.

An Impossible Idea:

I have always loved to write. I still have folders filled with old poems, stories and notes from when I was a kid. But I never considered myself a writer, and after I was diagnosed with Meniere’s disease, I didn’t write for a long time.

But nine months ago, as I was falling asleep I had an impossible idea. I realized that just maybe, I knew something that could help others and would be worth writing about.

I had successfully managed my Meniere’s symptoms for a while, but it had taken me so long to get to that point. My journey was chaos.

As I reflected back I realized that, for me, and for a long time, the missing ingredient was hope. I knew there had to be others who were still struggling. I wanted to start writing again. I wanted to share my story, but I was afraid.

I wrote five articles before I even created the blog. I was terrified to share my ideas with the world. When I finally set up the website and clicked publish for the first time, I panicked. It seemed like such a bad idea. Who was I to give advice on anything?

But slowly, I found all of you. I put myself out there and the community caught me with open arms. There were a lot of times when I was ready to give up. But you all kept me going when I wasn’t sure if I could… or if I should. I am forever grateful to the community and to all of my readers. You all have inspired me and helped me grow. I learn from you every day.

At some point, though, I realized the blog would never be big enough to say everything I needed to say.

Maybe I could write a book? No I could never write a book…that’s impossible. I dismissed the thought immediately. But it kept coming back. I couldn’t shake the feeling that it was something I needed to do.

Eventually I decided it was too important to not at least give it a try. It started with a list of 10 ideas. Those 10 ideas evolved into an outline. I dove deep and started researching to expand my understanding.

But I was absolutely overwhelmed. For several days I sat down to face the blank page. But the words wouldn’t come. How could I ever write a book?

Martin Luther King Jr. once said, “If I cannot do great things, I can do small things in a great way.”

My first real breakthrough came when I read this quote and changed my approach. Could I write a book? No, that was still impossible. But I could definitely write 300 words. I made a decision to sit down and write just 300 words every day. Most days it was a terrible experience. But often, I would come back the next day to find something beautiful left behind.

And as time went on, it started to build and build. Until one day, several months later, I realized that my manuscript was finished. 300 words at a time, I had accomplished the impossible.

I couldn’t help but smile. In my wildest dreams, I never thought I could write a book.

3d cover mock up square


So what impossible idea keeps you up at night?

If you are anything like me, there is probably something you want to do, right now. And while Meniere’s disease will limit you, you can overcome the fear. You can achieve the impossible, too.

For the ultimate secret is that most impossible things can be broken down into small possible pieces. And those pieces will slowly build over time.

I am proud and excited to announce that my book is finally near completion and will be available on Amazon in the next several weeks.

I have written the book that I wish I could have read when I was first diagnosed. But it’s not just for the newly diagnosed. It’s for everyone else too, no matter how long you have suffered. It’s a book that will even help your family and friends understand, and better support you.

The chaos, anxiety, and depression that come with Meniere’s disease can cripple you. There is enough conflicting information to make your head spin. It can destroy your quality of life.

But there is also so much hope. I wrote this book to show you that. To show you the potential and opportunity that lies trapped within you. To show you that there is always room for improvement and that you can learn to manage your symptoms and live in harmony with your disease. To show you that you can learn to thrive again.

And though I’m nervous to release my book out into the world, I am proud, and finally ready to put myself out there, one more time.

But no matter what next happens next, I encourage you to have always have hope. Find your impossible idea. Pursue it, nurture it, and share it with the world.

You can achieve the impossible, too.

Even with Meniere’s disease, you have the power to make a difference, never forget that.


I’m giving away 10 FREE advanced release eBook copies of my new book: Mind Over Meniere’s – How I Conquered Meniere’s Disease and Learned to Thrive!

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What is Autoimmune Disease!

The Immune System

Your immune system is the network of cells and tissues throughout your body that work together to defend you from invasion and infection. You can think of it as having two parts: the acquired and the innate immune systems.

The acquired (or adaptive) immune system develops as a person grows. It “remembers” invaders so that it can fight them if they come back. When the immune system is working properly, foreign invaders provoke the body to activate immune cells against the invaders and to produce proteins called antibodies that attach to the invaders so that they can be recognized and destroyed. The more primitive innate (or inborn) immune system activates white blood cells to destroy invaders, without using antibodies.

Autoimmune diseases refer to problems with the acquired immune system’s reactions. In an autoimmune reaction, antibodies and immune cells target the body’s own healthy tissues by mistake, signaling the body to attack them.

Autoimmune Diseases

Autoimmune diseases can affect almost any part of the body, including the heart, brain, nerves, muscles, skin, eyes, joints, lungs, kidneys, glands, the digestive tract, and blood vessels.

The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain, and swelling. How an autoimmune disease affects you depends on what part of the body is targeted. If the disease affects the joints, as in rheumatoid arthritis, you might have joint pain, stiffness, and loss of function. If it affects the thyroid, as in Graves’ disease and thyroiditis, it might cause tiredness, weight gain, and muscle aches. If it attacks the skin, as it does in scleroderma/systemic sclerosis, vitiligo, and systemic lupus erythematosus (SLE), it can cause rashes, blisters, and color changes.

Many autoimmune diseases don’t restrict themselves to one part of the body. For example, SLE can affect the skin, joints, kidneys, heart, nerves, blood vessels, and more. Type 1 diabetes can affect your glands, eyes, kidneys, muscles, and more.

No one is sure what causes autoimmune diseases. In most cases, a combination of factors is probably at work. For example, you might have a genetic tendency to develop a disease and then, under the right conditions, an outside invader like a virus might trigger it.

The list of diseases that fall into the autoimmune category includes

  • alopecia areata
  • autoimmune hemolytic anemia
  • autoimmune hepatitis
  • dermatomyositis
  • diabetes (type 1)
  • some forms of juvenile idiopathic arthritis
  • glomerulonephritis
  • Graves’ disease
  • Guillain-Barré syndrome
  • idiopathic thrombocytopenic purpura
  • myasthenia gravis
  • some forms of myocarditis
  • multiple sclerosis
  • pemphigus/pemphigoid
  • pernicious anemia
  • polyarteritis nodosa
  • polymyositis
  • primary biliary cirrhosis
  • psoriasis
  • rheumatoid arthritis
  • scleroderma/systemic sclerosis
  • Sjögren’s syndrome
  • systemic lupus erythematosus
  • some forms of thyroiditis
  • some forms of uveitis
  • vitiligo
  • granulomatosis with polyangiitis (Wegener’s)


The treatment depends on the disease, but in most cases one important goal is to reduce inflammation. Sometimes doctors prescribe corticosteroids or immunosuppressive drugs.

Progress and Promise

Further research should continue to enhance the understanding of the genetics and causes of autoimmune disorders and result in improvements in diagnosing and treating these diseases. For information on autoimmune disease research that is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, visit www.niams.nih.gov/Research/default.asp. For a listing of federally and privately supported clinical trials for a variety of autoimmune disorders, visit www.clinicaltrials.gov.

Key Words

Acquired immune system. The part of the immune system that develops as a person grows. It employs antibodies and immune cells to fight harmful substances.

Antibody. A special protein produced by the body’s immune system that recognizes and helps fight infectious agents and other foreign substances that invade the body.

Antigen. A foreign substance that triggers the production of antibodies when it is introduced into the body.

Autoimmune disease. A disease that results when the immune system mistakenly attacks the body’s own tissues.

Corticosteroids. Potent anti-inflammatory hormones that are made naturally in the body or synthetically (man-made) for use as drugs. They are also called glucocorticoids. The most commonly prescribed drug of this type is prednisone.

Diabetes, type 1. A condition in which the immune system destroys insulin-producing cells of the pancreas, making it impossible for the body to use glucose (blood sugar) for energy. Type 1 diabetes usually occurs in children and young adults.

Graves’ disease. An autoimmune disease of the thyroid gland that results in the overproduction of thyroid hormone. This causes such symptoms as nervousness, heat intolerance, heart palpitations, and unexplained weight loss.

Immune system. A complex network of specialized cells and organs that work together to defend the body against attacks by foreign invaders, such as bacteria and viruses.

Immunosuppressive drugs. Drugs that suppress the immune response and can be used to treat autoimmune disease. Unfortunately, because these drugs also suppress normal immunity, they leave the body at risk for infection.

Inflammation. A reaction of body tissues to injury or disease, typically marked by five signs: swelling, redness, heat, pain, and loss of function.

Innate immune system. The part of the immune system that is more primitive. It employs types of white blood cells called granulocytes and monocytes to destroy harmful substances.

Psoriatic arthritis. A type of arthritis associated with psoriasis, a chronic skin disease that occurs when cells in the outer layer of the skin reproduce faster than normal.

Rheumatoid arthritis. A disease in which the immune system attacks the linings of the joints. This results in joint pain, stiffness, swelling, and destruction.

Scleroderma/systemic sclerosis. An autoimmune disease characterized by abnormal growth of connective tissue in the skin and blood vessels. In more severe forms, connective tissue can build up in the kidneys, lungs, heart, and gastrointestinal tract, leading in some cases to organ failure.

Systemic lupus erythematosus. An autoimmune disease affecting primarily young women. Many parts of the body can be affected, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Thyroiditis. An inflammation of the thyroid gland that causes the gland to become underactive. This results in symptoms such as fatigue, weakness, weight gain, cold intolerance, and muscle aches.

Vitiligo. A disorder in which the immune system destroys pigment-making cells called melanocytes. This results in white patches of skin on different parts of the body.

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The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The NIAMS information clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS website at www.niams.nih.gov.

The National Institutes of Health (NIH)—The Nation’s Medical Research Agency— includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

For Your Information

This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact

U.S. Food and Drug Administration

Toll Free: 888-INFO-FDA (888-463-6332)
Website: http://www.fda.gov

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Supporting people with invisible illnesses