Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder?
Abstract
Patients with vestibular vertigo syndromes often suffer from anxiety and depression, whereas patients with psychiatric disorders often experience subjective unsteadiness, dizziness, or vertigo. Thus, it has been hypothesized that the vestibular system may be interlinked with the emotion processing systems. The aim of the current study was to evaluate this hypothesis by correlating vestibular and psychiatric symptoms with the course of the disease over 1 year. This interdisciplinary, prospective, longitudinal study included a total of 68 patients with acute vestibular vertigo syndromes. Four subgroups of patients with benign paroxysmal positioning vertigo (BPPV, n=19), acute vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), or Menière's disease (MD, n=8) were compared. All patients underwent neurological and neuro-otological examinations and filled out standardized self-report inventories including the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Symptom Checklist 90R (GSI, SCL-90R) at five different times (T0-T4) in the course of 1 year. VM patients experienced significantly more "vertigo and related symptoms" (VSS-VER), "somatic anxiety and autonomic arousal" (VSS-AA), and "vertigo induced handicap" (VHQ) than all other patients (P<0.001-P=0.006). Patients with a positive history of psychiatric disorders had significantly more emotional distress (GSI, SCL-90R), regardless of the specific phenomenology of the four diagnostic subgroups. Finally, fluctuations of vestibular excitability correlated positively with the extent of subjectively perceived vertigo. VM patients are significantly more handicapped by vertigo and related symptoms. They show significantly elevated fluctuations of vestibular excitability, which correlate with the (subjective) severity of vertigo symptoms.
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Patients with family or personal histories of anxiety disorders pre-dating the onset of vestibular symptoms had an increased risk of developing persistent dizziness or CSD after precipitating events.
“Patients with family or personal histories of anxiety disorders pre-dating the onset of vestibular symptoms had an increased risk of developing persistent dizziness [7] or CSD [80] after precipitating events.”
No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes.
“No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes [7, 12, 23, 28, 30, 79].”
These investigations found PPPD-like chronic dizziness or persistent VV in about 25% of patients after 3-12 months of follow-up, despite otherwise adequate compensation or recovery from the initial illnesses.
“These investigations found PPPD-like chronic dizziness [7, 28, 30] or persistent VV [23] in about 25% of patients after 3–12 months of follow-up, despite otherwise adequate compensation or recovery from the initial illnesses.”
Investigators studying PPV, CSD, SMD, and VV have identified pathophysiologic processes that may be applicable to PPPD, including anxiety-related personality traits as a possible risk factor and high levels of anxiety and vigilance about acute symptoms during precipitating events as initial pathologic responses.
“Investigators studying PPV, CSD, SMD, and VV have identified pathophysiologic processes that may be applicable to PPPD, including anxiety-related personality traits as a possible risk factor [86, 88, 89] and high levels of anxiety and vigilance about acute symptoms during precipitating events as initial pathologic responses [7, 23, 28, 30].”
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Why is vestibular migraine associated with many comorbidities?
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A method for prediction functional dizziness after benign paroxysmal positional vertigo
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Psychological assessment of individuals with Mal de Débarquement Syndrome
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Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness
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The Effectiveness of Vestibular Rehabilitation in Vestibular Migraine: A Systematic Review
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Mental Health Education and Utilization Among Patients with Vestibular Disorders
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Sense of direction in vestibular disorders
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慢性めまい (PPPD および加齢性前庭障害) の診断と治療
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- Authors
- Best, C., Tschan, R., Eckhardt-Henn, A., & Dieterich, M.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Best, C.
- ORCID
- Dieterich, M.
- Venue
- Neuroscience
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 164
- Issue
- 4
- Pages
- 1579-1587
- ISSN
- 0306-4522 (ISSN-L)
- OpenAlex
- W1999864054
- Cited by
- 142
- References
- 53
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 10 · 2023: 13 · 2022: 16 · 2021: 9 · 2020: 12 · 2019: 8 · 2018: 7 · 2017: 5 · 2016: 7 · 2015: 3 · 2014: 8 · 2013: 5 · 2012: 6
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (DFG (EC 220/2-1)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- vestibular vertigo, vestibular migraine, benign paroxysmal positional vertigo, acute vestibular neuritis, Meniere's disease, dizziness, anxiety, depression, psychological distress, vestibular excitability, emotional distress, clinical course
- MeSH terms
- Dizziness, Female, Humans, Male, Meniere Disease, Middle Aged, Migraine Disorders, Prospective Studies, Stress, Psychological, Syndrome, Vertigo, Vestibular Diseases, Vestibular Neuronitis
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