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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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In the citing paper
“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.”
In the citing paper
“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].”
In the citing paper
“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.”
In the citing paper
“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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慢性めまい (PPPD および加齢性前庭障害) の診断と治療
堀井, 新. (2023) · Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho(Tokyo) · doi:10.3950/jibiinkotokeibu.126.11_1195 · Cited by 2
Short-term effects of lifestyle modification on vestibular migraine
McDonald, K., Wasoff, A., Picou, E. M., Watford, K. E., Brignola, E., Romero, D. J., Schuster, D., Krolewicz, S., & Roberts, R. A. (2024) · International Journal of Audiology · doi:10.1080/14992027.2024.2409763 · Cited by 2
Goto, F., Kaneda, S., Wasano, K., & Okami, K. (2025) · Otolaryngology Case Reports · doi:10.1016/j.xocr.2025.100664 · Cited by 2
Rutenkröger, M., Scheer, M., Rampp, S., Strauss, C., Schönfeld, R., & Leplow, B. (2026) · Scientific Reports · doi:10.1038/s41598-026-64384-0 · Cited by 2
The level of β-endorphin, chronic stress, and depression associated with vestibular pathology
Kunelskaya, N. L., Гусева, А. Л., & Дмитриевич, Ч. С. (2015) · Russian Bulletin of Otorhinolaryngology · doi:10.17116/otorino201580112-16 · Cited by 2
Best, C., Krämer, H. H., & Dieterich, M. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13160-7 · Cited by 1
Self-citationComorbidity Patterns Between Hearing Loss and Symptomatic Dizziness in Middle‐Aged and Older Adults
Liu, C., Wu, X., Li, J., Zhang, J., Gao, Y. Z., Wang, D.-Y., & Wang, Q. (2026) · World Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.1002/wjo2.70078 · Cited by 1
Naudé, A., & Kanji, A. (2026) · Journal of Vestibular Research · doi:10.1177/09574271261465715 · Cited by 1
Beyond Vertigo- Perceptual Postural Phobic Dizziness (PPPD): Our experience
Tripathi, S. M., Tripathi, S., Shantha, N., & Goyal, S. (2021) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-021-02984-0 · Cited by 1
The Relationship Between Benign Paroxysmal Positional Vertigo and Anxiety
Gul, A. I., Özkırış, M., Aydın, R., Simsek, G. G., & Saydam, L. (2014) · Turkiye Klinikleri Journal of Medical Sciences · doi:10.5336/medsci.2014-39518 · Cited by 1
Vestibular Migraine: Classification and Clinical Features
Lempert, T. (2014) · Springer eBooks · doi:10.1007/978-3-319-07022-3_6 · Cited by 1
Anxiety and depression associated with vertigo: a cross sectional study from India
Asha, C. S., Kumar, C. T. S., Punnoose, V. P., & Jacob, J. (2019) · International Journal of Otorhinolaryngology and Head and Neck Surgery · doi:10.18203/issn.2454-5929.ijohns20190446 · Cited by 1
Metadata
- 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 › Cardiology and Cardiovascular Medicine › 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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