Are Smartphones Really Addictive? What’s the Evidence?

 

 

Although the term “addiction” is usually applied to ingested substances such as drugs or food, we can also become addicted to things and behaviors. The pleasure centers in our brain respond to anything that provides us with a reward, and smartphones are expert at providing those rewards. Although it is not “officially” classified as an addiction, many who use smartphones are increasingly showing signs of addictive habits.

A study conducted on 1,600 professionals by Leslie Perlow, PhD, from Harvard Business School, found the following interesting statistics:

  • 70% of subjects reported checking their smartphone within an hour of waking.
  • 56% check their phone within an hour of going to bed.
  • 48% check their Smartphone over the weekend, including Friday and Saturday nights.
  • 51% check their phone continuously while on vacation.
  • 44% reported they would experience “a great deal of anxiety” if their phone was lost and they could not replace it for a week.

An estimated 56% of all Americans now own a Smartphone. Videos, Twitter, Facebook updates and the occasional pleasant e-mail are all ways in which we become “attached” to our smartphones. Psychologist David Greenfield, PhD, who specializes in helping people deal with technology addiction, says that computer technologies can alter your mood and trigger feelings of pleasure. He notes “It’s like slot machines. We’re seeking that pleasurable hit.”

Although it seems a harmless enough addiction, excessive smartphone use can begin to interfere with your daily life. And this becomes a larger and larger risk as people use it more often in ways that cause them to “disconnect” from the real world around them while “staying connected” to the virtual one online.  Examples are easy to find:

  • Actually ignoring a friend at lunch to update a Facebook status about having lunch with a friend.
  • Texting at the movie theater.
  • A disturbing 10% of smartphone users have admitted to texting while having sex. For young adults aged 18-34, this number jumps up to 20%!
  • Using a smartphone while driving. Texting while driving is 6 times more dangerous than driving while drunk.

Nicholas Carr, author of the book The Shallows: What the Internet is Doing to Our Brains, believes that smartphones are interfering with our brains in a way that reduces our ability to concentrate and think properly. He says, “It’s an environment of almost constant interruptions and distractions. The smartphone, more than any other gadget, steals from us the opportunity to maintain our attention, to engage in contemplation and reflection, or even to be alone with our thoughts.”

The reason for our smartphone addiction is likely tied to our primitive roots. For much of our evolutionary history, it has been very important for us to be aware of everything happening around us. Carr explains, “That instinct probably helped us survive when we were cave men and cave women. I’m sure one of the main reasons people tend to be so compulsive in their use of smartphones is that they can’t stand the idea that there may be a new bit of information out there that they haven’t seen.”

In particularly “wired” societies—South Korea, where smartphone penetration is over 100%, is a great example—the issue of technology addiction among children is emerging as a national health problem. The South Korean government estimates that 1 in 5 students is now addicted to smartphone use.  They define “addiction” as spending 7 or more hours each day using the device and experiencing distinct signs of psychological withdrawal—anxiety, insomnia and depression—when forced to go without.  There is already compelling evidence that smartphone use is not only distracting students from their studies, it’s also damaging children’s interpersonal skills.  For instance, they’re becoming “very bad at reading facial expressions” as they spend more time texting and less time interacting face-to-face.

At SEHC, we are here to help! Call us at 910-790-3666.

What’s Occupational Health and Safety All About, and How Can a Chiropractor Help?

 

 

The Occupational Health and Safety Administration (OSHA) estimates that workplace-related injuries cost businesses nearly $170 billion each year. With money like this at stake, it’s easy to see that keeping your workers healthy through an Occupational Health and Safety (OHS) program could have a very high return on investment. And chiropractors can play a major role in helping companies to manage risk and improve productivity.

An estimated 60 to 70 percent of all workplace-related injuries involve the musculoskeletal system. And of every worker’s compensation dollar spent, 90 cents is used for the treatment of this type of injury. Those professions with the highest rates of musculoskeletal injury are trucking and vehicle operations, manufacturing, nursing and healthcare, and work involving repetitive motion or prolonged periods of sitting.

Gerard Clum, D.C., is a spokesperson for the Foundation for Chiropractic Progress (F4CP) who attended the 2013 American Occupational Health Conference (AOHC). He explained, “Doctors of chiropractic provide a conservative, patient-centered approach that is well-documented for its clinical and economic value. When included as members of occupational health teams, doctors of chiropractic can facilitate and drive reduced costs and better clinical outcomes, as well as improvements in safety, general health and communication.”

Many chiropractors have received postgraduate training in occupational health and applied ergonomics. This makes them particularly valuable as members of an OHS team that may include such other professionals as occupational medical physicians, occupational nurses and human resources coordinators. Preventive medicine and risk management will become increasingly important with the implementation of the new Affordable Care Act, which will be rolling out slowly over the next 7 years.

Among other things, chiropractors are able to provide on-site chiropractic care, including structural care, ergonomic improvements and advice on lifestyle and nutrition. This can contribute to creating lower workers’ compensation premiums, a reduced rate of absenteeism, and greater productivity, worker morale and employee retention. In addition, many chiropractors are certified to provide on-site DOT screenings and physical exams to employees, saving employers thousands of dollars.

Chiropractors are excellent at providing preventive care, which can help save businesses considerable amounts of money. But in addition to the financial benefit, employers benefit further by making their employees feel valued, which increases worker satisfaction. Daniel R. Nobbe, from Fiberteq LLC in Danville, IL, said “There are many benefits from developing a safety culture at your company – none of which is more valuable than employee loyalty. When employees know you care about their personal well-being and you prove that to them in their workplace, it increases morale, engagement, awareness, motivation and productivity.” And including a skilled chiropractor as part of the OHS team is part of this strategy.

At SEHC, we are here to help! Call us at 910-202-4341.

What Is a “Subluxation”?

Subluxations are the primary reason for visiting your chiropractor. A subluxation occurs when one or more of the spinal vertebrae move out of position due to injury, stress or chemical imbalances. This can put pressure on the spinal nerves, causing them irritation, and resulting in pain. Your chiropractor can locate these subluxations and gently realign your spinal vertebrae to remove the pressure on your spinal nerves.

There is more to a subluxation, however, than simply the vertebrae moving out of place. Chiropractors refer to the state of subluxation as a vertebral subluxation complex (VSC). This refers to five different components of a subluxation that are affecting your body at the same time. These include the following conditions:

  • Kinesiopathology – The loss of correct vertebral positioning in relation to the vertebrae above and below. This makes it difficult to bend and turn.
  • Neuropathology – An irritation or injury to the spine’s nerve roots due to stretching, compression or chemical irritation from neighboring spinal structures. This disruption to the nerves can cause problems elsewhere in the body.
  • Myopathology – Pathological changes to the muscles supporting the spine, which includes spasms, weakness, hypertonicity, muscle atrophy, fibrosis and inappropriate functioning. The scar tissue that results from these conditions results in more frequent subluxations that require adjustment.
  • Histopathology – Pathological changes to the spinal tissues, which can cause bone spurs and other abnormal bone growth from the vertebrae and their joints, as well as adhesions and fibrosis of the spinal muscles and ligaments, inflammation, swelling, and dehydration, bulging, tearing and degeneration of the spinal discs.
  • Pathophysiology – The biochemical abnormalities that take place in the region of the spine, such as biochemical waste products and inflammatory biochemicals coming from injured tissues.

Among the signs that you may have a subluxation are neck and back pain, soreness or stiffness, headache, joint pain, muscles spasms, and numbness, pain or tingling in the extremities.

A number of things can cause VSC, including auto accidents, alcohol, chemical imbalances, improper lifting, repetitive motion, bad posture, emotional stress and extended periods of sitting. When a person has VSC, it leads to considerable changes in the soft tissue in the area of the spine and also in the other tissues and organs of the body due to the disruption of proper nerve impulses coming from and returning to the spinal cord.

Your chiropractor will be able to detect where these subluxations are in your spine and correct them with a spinal adjustment either using only their hands or assisted by a hand-held instrument to deliver a quick and gentle correction to the misaligned vertebrae. Correcting these misalignment’s sometimes takes a little time, as the tissues need to adjust to the new correct positioning of the vertebrae.

Visit our offices in Wilmington, Leland, Shallotte and Jacksonville for all your Chiropractic care!

At SEHC, we are here to help! Call us at 910-202-4341.

What is a “Pinched Nerve”?

A “pinched nerve” refers to a condition in which a nerve is compressed by surrounding tissue, such as ligament, cartilage, tendon or bone. The term “pinched nerve” is not a standard medical expression, but it’s an intuitive expression that almost anyone will understand.

Nerves radiate from your brain, down your spine and to all other parts of the body. Signals are sent from and to the brain along the nerves, and if a nerve is compressed (“pinched”), it will interfere with proper signal transmission. Usually, this will manifest as pain, not only at the site of compression, but sometimes radiating from that point to surrounding parts of the body. Misalignment of the spine can result in pinched nerves that can give you back pain and even a deadening ache or sensitivity along your arms (cervical radiculopathy) or legs (sciatica).

Any pain of this sort is a warning signal that there is a problem that should be treated right away. Left untreated, pinched nerves can lead to a loss of the protective barrier around the nerves which could generate fluid buildup. And this fluid would create swelling, more pressure, more pain, and possibly scarring. When nerves have been scarred, they may no longer function properly.

Pain isn’t the only indication of a pinched nerve. Sometimes a compressed nerve will generate numbness or tingling, a burning or “pins and needles” sensation, or even weakness during certain activities.

Pinched nerves can occur more often when the following risk factors are involved:

  • Overuse—Repetitive actions such as movements during work or while involved in a hobby or sport.
  • Posture—Bad posture creates more pressure on the spine and the nerves traveling through it.
  • Gender—Women’s carpal tunnels are smaller and are at greater risk for carpal tunnel syndrome.
  • Rheumatoid arthritis—Inflammation of any kind can compress nerves, especially at the joints.
  • Obesity—Increased body weight can increase pressure on nerves throughout the body.
  • Bone spurs—Bone thickening (from conditions such as osteoarthritis) or trauma can lead to bone spurs that stiffen the spine and narrow the space through which the nerves pass.

Mainstream medicine frequently recommends drugs, including NSAIDs, oral corticosteroids, narcotics (for emergency, short-term pain relief) and steroid injections to treat the symptoms of a pinched nerve. The Mayo Clinic suggests that patients can sometimes recover within a few days or weeks from pinched nerves with rest and additional “conservative treatments.” Other mainstream medical treatments may include physical therapy, a splint to immobilize a limb to give it a bit of rest, or surgery.

A chiropractor specializes in nerve health and non-invasive methods of reducing pain and restoring proper function, including spinal adjustments and other treatments that take the pressure off the nerves without the need for drugs or surgery. Sometimes a single adjustment can lead to immediate relief. In other cases, repeat visits may be required for full recovery. If you or someone you care about is suffering from a pinched nerve, you should know that there are alternatives to drugs and surgery and that chiropractic care has proven effective in treating the source of the problem so it is less likely to recur in the future.

Call Southeastern Healthcare for your Chiropractic needs! We offer FREE shuttle to/from our offices!

At Southeastern Healthcare, we are here to help! Call us at (910) 790-3666

What is a “Back Spasm”?

 

 

A back spasm can occur when the muscles supporting the spinal column, particularly those in the lower back, become overworked. If the muscles suddenly contract near the nerve roots around the spinal cord, this condition can be extremely painful.

Muscles that are overstretched or worked more than usual can become tender and inflamed. The pain may first become noticeable when you are twisting your back, or are pushing or pulling something, particularly if you are moving something heavy. Sudden movements in particular are likely to trigger back spasms. Playing golf, for example, in which the back twists quickly as the golfer swings, can cause the back to spasm. Weightlifting, baseball and football are other sports that carry a higher risk of back spasm. Even something as seemingly safe as gardening can cause back spasms, since it usually involves bending and turning. If the activity is not stopped immediately, the spasms are likely to get worse.

Among other things that can increase your risk of suffering a back spasm are:

  • Weak stomach muscles
  • Tight hamstrings
  • A tipped pelvis
  • Lordosis (an exceptional curvature of the lumbar spine)
  • A back condition such as spondylolysis, arthritis or spinal stenosis

 

Typical back spasm treatments usually involve resting the back first, then—as it heals—strengthening the muscles that support the spine. Bed rest is not usually recommended for the long term, as it can actually hinder the healing of the back. You should try to keep active, but be sure not to put any strain on the back muscles. While resting, experts recommend that you lie on your back on the floor with a pillow under your knees, or with your knees bent and your legs resting on a chair. Acetaminophen or anti-inflammatory pain relievers such as ibuprofen are often recommended in the first days, though they should not be taken on an extended basis due to the damage they can do to your stomach and liver. You can also apply heat for 20 to 30 minutes at a time to help soothe sore back muscles.

When your back has sufficiently healed, you can slowly begin to introduce more movement. A visit to your chiropractor is always a good idea, as he or she can remove any spinal subluxations.

All our offices offer massages to help with back spasms! Call the Southeastern Healthcare office most convenient to you, we have 7 locations in the Wilmington, Jacksonville, Leland and Shallotte area!

At Southeastern Healthcare, we are here to help! Call us at (910) 790-3666

What is “Radiating Pain” and How Can Chiropractic Help?

 

 

If you have ever had a case of sciatica, in which pain seems to start in your lower back or hip and radiate down your leg to your foot, you have suffered an example of what is referred to as “radiating pain.” The medical term for pain the starts in one area and travels to another is radiculitis, and although it is not the most common form of nerve pain, it causes a lot of misery for those who suffer from it.

True radiating pain is usually the result of a nerve or nerve root in the spinal cord being subject to pressure of some sort, whether through inflammation, injury or spinal subluxation. For example, a herniated disk may create radiating pain because it has bulged out of its normal place and may impinge on a nerve root extending from the spinal cord.

The nerves that run the length of the spinal cord from neck to tailbone and branch out to the left and right are called the radicular nerves. When these are injured or compressed they are more likely to radiate pain than the other types of nerves in our body. If there is a neck injury, for example, pain may radiate down the arm to the fingertips. The pain of something like tendonitis, however, is from pressure on the nerves in the elbow and forearm and does not generally radiate. Some people think they have radiating pain, but the pain is instead often just due to myofascial trigger points that cause a more diffuse pain that seems to radiate out from one area. This is caused by tense muscles and scar tissue that has built up trapping nerves in the muscles, tendons and ligaments.

Chiropractors are expert at treating radiating pain. Your chiropractor will first take a thorough history, examine you, and may order diagnostic tests such as an x-ray or an MRI to determine if your problem may be due to a herniated disc, spinal stenosis or another condition that is not apparent from a physical examination.

A chiropractic adjustment can address any spinal misalignments that may be impinging on spinal nerves, taking the pressure off the nerve and reducing pain. In addition, many chiropractors utilize additional therapies that can free trapped nerves, such as the Active Release Technique (ART). A chiropractic ART therapist will be able to break up the fibrous adhesions and scar tissue that has built up in the soft tissue, freeing trapped nerves.

If you are experiencing “radiating pain” please call the Southeastern Healthcare office nearest you. We have 7 locations including Jacksonville, Shallotte, Leland and 4 in the Wilmington area! Phone numbers and addresses on on the website!

At Southeastern Healthcare, we are here to help! Call us at (910) 790-3666

 

What’s the Difference Between an MD and a DC?

It’s important to know the basic differences between an MD (Medical Doctor) and a DC (Doctor of Chiropractic) so that you understand the unique role that each type of medical professional plays in helping you to maintain or regain your health.

MDs and DC’s are both licensed healthcare providers. They examine, diagnose and treat patients. However, most MD’s have more hours of training in physiology, whereas DCs typically have more hours of anatomy training. Their methods of practice may help explain this difference in emphasis. DCs are experts in musculoskeletal health and general wellness. Like an MD, a DC will use diagnostic imaging, lab tests, clinical exams and questionnaires to determine a diagnosis, but the course of treatment will be different. MDs tend to prescribe pharmaceuticals and surgery to treat patients, whereas DCs use a more holistic approach involving a variety of hands-on treatments as well as advice on diet and exercise.

Office visits are also often quite different experiences. On a typical visit to an MD, you will likely be asked by a nurse or assistant to fill out paperwork and provide information about your condition. Then the MD will visit you, look at the information, perhaps perform a brief clinical examination, and quickly prescribe a treatment. In the course of doing this, most doctors will take only a small amount of time to understand your overall health picture. And treatment will usually involve drugs and/or medical procedures.

It is not uncommon for patients to have a more personal relationship with their DC than with their MD. Visits to a DC also tend to be more involved. The chiropractor will speak with you at length about not only your physical symptoms, but your lifestyle habits as well. He or she will examine you, perform any necessary tests, discuss possible treatment options, and provide appropriate manual therapies. Together, these treatment methods are sometimes referred to as “physical medicine”.  These may include targeted spinal adjustments, therapeutic massage, disc decompression, laser therapy, electrical stimulation and hot and cold treatments as well as structured exercise and stretching programs. In addition, the chiropractor may also make specific suggestions about your nutrition, day-to-day environment and physical activity.

In general, musculoskeletal problems (particularly those related to back, neck and joint pain) are better treated by a DC. However, many chiropractors have also developed specialized expertise now the basic differences between an MD (Medical Doctor) and a DC (Doctor of Chiropractic) so that you understand the unique role that each type of medical professional plays in helping you to maintain or regain your health.

Call one of our 7 locations at Southeastern Healthcare for more information and all your Chiropractic needs!

 

 

The Benefits of Iron

If you’ve been feeling sluggish or short of energy lately, it may be that you haven’t been getting enough iron in your diet. Iron is a mineral necessary for the production of energy and the transport of oxygen throughout the body. According to the World Health Organization, approximately 80% of the world’s population has an iron deficiency, with as many as 30% having anemia as a result. However, too much iron in your diet isn’t a good thing either—it can be toxic and may even result in death.

The red blood cells that deliver oxygen to every one of our body’s other cells require iron for their production. Nearly two thirds of the body’s iron is stored in the blood in the form of oxygen-transporting hemoglobin. So if levels of iron are low, the body does not get enough oxygen to be able to function properly. This is why those with anemia (a deficiency in red blood cells) feel chronically tired. Without enough oxygen, the body has little energy. A deficiency in iron also compromises the immune system, leaving you more vulnerable to viruses and bacterial infections

The recommended daily intake of iron is as follows:

  • Infants 7 – 12 months: 11 mg/day
  • Children 1 – 3 years: 7 mg/day
  • Children 4 – 8 years: 10 mg/day

Iron can be categorized into two types: heme iron and non-heme iron. Although both are important, meeting your daily iron requirement with heme iron is easier because it is more easily absorbed by the body. Approximately 25%-30% of heme iron is absorbed from the foods we eat, whereas only around 3% of non-heme iron is absorbed.
Children, people with gastrointestinal disorders, the elderly, and women of childbearing age are at the greatest risk of iron deficiency. Since the body has the ability to store iron, a deficiency does not usually happen overnight. But if someone is unable to replenish their store of iron (during famine or illness, for example) then they may develop anemia. Heme iron is only found

in animal products such as meat, poultry and fish, which is why vegetarians and vegans can be at greater risk of iron deficiency. Non-heme iron can be found in vegetables, particularly dark green leafy vegetables, and pulses such as beans and lentils.
To encourage iron absorption, eat foods that are high in vitamin C and high in iron at the same time. Vitamin C aids in the absorption of non-heme iron. There are also some foods that hinder non-heme iron absorption, such as foods high in tannins (like tea and coffee), calcium, phytates (legumes and whole grains) and polyphenols. Because tea and coffee inhibit iron absorption, they should not be drunk during meals.
If your doctor finds that you have low iron levels, he or she may prescribe a supplement. Always take exactly the amount prescribed, as it is possible to take too much, which can cause severe organ damage. Those with the disorder hemochromatosis, a condition in which the body stores excessive amounts of iron, must have their blood tested regularly so as to avoid organ damage.

Call Southeastern Healthcare for more information at 910-

Look Who Else Uses Chiropractic Care: Elite Cheerleaders

Sprains, strains and lower back pain are very, very common among cheerleaders. In fact, the National Center for Catastrophic Sports Injury Research lists cheerleading as the most dangerous sport for women. Anyone who watches elite cheerleaders in action, either during a game or at competitions, has some idea why this might be.

Cheerleading is a very physically demanding sport, particularly when participants perform routines that involve gymnastics or acrobatics or execute maneuvers that require them to support a lot of weight. Performing well as a cheerleader requires excellent balance, strength and range of motion. Chiropractic care can help prevent injuries and—when they do happen—can help cheerleaders recover more quickly.

In fact, chiropractic has made such a difference in professional cheerleading that the Washington Redskins Cheerleaders joined the Foundation for Chiropractic Progress to let others know how much chiropractic care helps both their performance and their musculoskeletal health. Both cheerleader training and the performances during the game take a toll on the body. Redskins cheerleader Amanda Mitchell says, “People don’t view cheerleading as a competitive sport, but you have to try out every single year in this industry and it takes a large toll on your body. Without chiropractic care I would not have made it past my first year. After receiving treatment, I began to notice the pain starting to subside as well as improvement in flexibility during performances.”

And when injuries occur—and they are very common among cheerleaders—getting back in condition as soon as possible is important. Professional cheerleaders find that with the help of chiropractic care they can be back in performance mode much faster. According to Redskins cheerleader Chelsea Causey, “I’ve experienced multiple injuries during my career as a cheerleader—everything from pulled hamstrings to sprains and even lower back pain—setbacks that chiropractic care has always helped me recover from.”

Studies show that chiropractic is an effective tool to prevent and treat sports-related injuries. One study published in the Journal of Manipulative and Physiological Therapeutics was performed by Dr. Jay Greenstein and colleagues on 43 professional football cheerleaders who underwent a season-long chiropractic hamstring intervention. Hamstring and other lower body strains account for half of all cheerleading injuries. Greenstein notes that “After the season closed, we found that those who had reported hamstring injury-related pain between June and September showed a significant decrease in pain after receiving treatment.”

Dr. Alex Vidan, chiropractor to the St. Louis Rams cheerleaders says, “The benefits of chiropractic treatment are felt immediately. Along with providing relief from pain, chiropractic also facilitates healing, which means there’s less downtime after an injury.” He added, “The squad performs a lot more than people think, making special appearances, and there’s a lot of travel involved, all of which can take their toll physically. The Rams cheerleaders, like many others, have found that chiropractic methods, which are gentle and noninvasive, offer relief and foster sound physical health.”

At Southeastern Healthcare, we are here to help! Call us at (910) 796-3666

Vertigo Causes and Treatment Options

If you’ve ever felt the sensation of spinning or that the world is spinning around you, you’ve experienced what is sometimes called vertigo. It is most often due to a problem with the inner ear. The vestibular system in our inner ear is responsible for keeping us aware of where we are located in space. The vestibulocochlear nerve sends signals to the brain about our body’s balance and position, and if this system is disturbed in any way, vertigo is often the result.

In addition to the spinning sensation, symptoms of vertigo include feelings of nausea, vomiting, sweating, difficulty standing, feeling unbalanced, headache, ringing in the ears or hearing loss, and abnormal or jerking eye movements.

Among the most common causes of vertigo are the following:

  1. Benign paroxysmal positional vertigo (BPPV) – Probably the most common cause of vertigo, particularly in those over age 60, BPPV is due to calcium carbonate particles called canaliths becoming dislodged and irritating the inner ear.
  2. Labyrinthitis or vestibular neuritis – Infections of the inner ear that are often due to a virus cause inflammation in the area of the vestibulocochlear nerve, sending inaccurate signals to the brain about the body’s position. This is why people with inner ear infections are often dizzy or walk in an unsteady manner.
  3. Ménière’s disease – A chronic inner ear disorder with symptoms including dizziness, tinnitus and hearing loss that can come and go.
  4. Migraine headaches – Vestibular migraines are migraines with vertigo involved, and those with balance disorders often have a family history of migraines.
  5. Stroke, tumor or multiple sclerosis – These are much less common causes of vertigo, involving problems with the brain and central nervous system.

involving problems with the brain and central nervous system.
One of the simplest treatments for BPPV is something known as a canalith repositioning procedure. This procedure moves the calcium particles out from the inner ear’s sensing tubes and into a different part of the inner ear where they cause no harm and are safely absorbed. Doctors, chiropractors and other therapists who are familiar with the procedure can perform the procedure in a matter of minutes.

One of the most commonly used of the procedures is called the Epley Maneuver. This treatment involves the patient lying on his or her back on a bed or table. The patient’s head should be hanging slightly over the edge and tilted 45 degrees toward the problem ear. The physician then moves the patient’s head into four different positions for a couple of minutes each until it is tilted 90 degrees toward the other ear. This procedure has been found to cure vertigo from BPPV approximately 90% of the time.

Vertigo due to inner ear infections will usually clear up once the infection is gone. Medicines are sometimes prescribed to help reduce symptoms of vertigo that are related to migraines or Ménière’s disease.