Spatial anxiety contributes to the dizziness-related handicap of adults with peripheral vestibular disease.

In subjects with peripheral vestibular disease and controls, we assessed: 1. The relationship between spatial anxiety and perceived stress, and 2. The combined contribution of spatial anxiety, spatial perspective-taking, and individual cofactors to dizziness-related handicap. 309 adults participated in the study (153 with and 156 without peripheral vestibular disease), including patients with bilateral vestibular deficiency, unilateral deficiency (evolution <3 or ≥3 months), Meniere's disease, and Benign Paroxysmal Positional Vertigo. Assessments included: general health, personal habits, spatial anxiety (3-domains), perceived stress, spatial perspective-taking, dizziness-related handicap (3-domains), unsteadiness, sleep quality, motion sickness susceptibility, trait anxiety/depression, state anxiety, depersonalization/derealization. After bivariate analyses, analysis of covariance was performed (p ≤ 0.05). Spatial anxiety was related to unsteadiness and perceived stress, with an inverse relationship with trait anxiety (ANCoVA, adjusted R2 = 0.27-0.30, F = 17.945-20.086, p < 0.00001). Variability on perspective-taking was related to vestibular disease, trait and state anxiety, motion sickness susceptibility, and age (ANCoVA, adjusted R2 = 0.18, F = 5.834, p < 0.00001). All domains of spatial anxiety contributed to the Physical domain of dizziness-related handicap, while the Navigation domain contributed to the Functional domain of handicap. Handicap variability was also related to unsteadiness, spatial perspective-taking, quality of sleep, and trait anxiety/depression (ANCoVA, adjusted R2 = 0.66, F = 39.07, p < 0.00001). Spatial anxiety is related to perceived stress in adults both with and without vestibular disease, subjects with trait anxiety rated lower on spatial anxiety. State anxiety and acute stress could be helpful for recovery after peripheral vestibular lesion. Spatial anxiety and perspective-taking contribute to the Physical and Functional domains of dizziness-related handicap, possibly because it discourages behavior beneficial to adaptation.

Neurotology symptoms at referral to vestibular evaluation.

BACKGROUND: Dizziness-vertigo is common in adults, but clinical providers may rarely diagnose vestibular impairment and referral could be delayed. To assess neurotology symptoms (including triggers) reported by patients with peripheral vestibular disease, during the year just before their referral to vestibular evaluation. METHODS: 282 patients with peripheral vestibular disease and 282 control subjects accepted to participate. They had no middle ear, retinal, neurological, psychiatric, autoimmune or autonomic disorders. They reported their symptoms by a standardized questionnaire along with their anxiety/depression symptoms. RESULTS: Patients were referred after months or years from the onset of their symptoms, 24% of them reported frequent falls with a long clinical evolution; 10% of them reported no vertigo but instability related to specific triggers; 86% patients and 12% control subjects reported instability when moving the head rapidly and 79% patients and 6% control subjects reported instability when changing posture. Seven out of the 9 symptoms explored by the questionnaire allowed the correct classification of circa 95% of the participants (Discriminant function analysis, p < 0.001). High blood pressure, dyslipidemia and anxiety/depression symptoms showed a mild correlation with the total score of symptoms (multiple R2 =0.18, p < 0.001). CONCLUSIONS: Late referral to vestibular evaluation may underlie a history of frequent falls; some patients may not report vertigo, but instability related to specific triggers, which could be useful to prompt vestibular evaluation. High blood pressure, dyslipidemia and anxiety/depression symptoms may have a mild influence on the report of symptoms of vestibular disease in both, patients and control subjects.

[Disability due to auditory and vestibular dysfunction in a specialized care center]. / Discapacidad por enfermedad auditiva y vestibular en un centro de atención especializada.

OBJECTIVE: To assess the frequency and characteristics of the disability associated with hearing loss and vestibular disease in a Specialized Medical Center of the Mexican Social Security Institute. METHODS: 530 patients agreed to participate. They were assessed due to hearing loss (n = 252) and vestibular disease (n = 278), 54% and 50% of them worked. After a clinical evaluation and administration of a symptom questionnaire, they were asked about the frequency and days ofdisability to perform daily life activities related to their audiological or vestibular disease and how often they visited the physician during the last year because of their symptoms. RESULTS: Hearing loss patients visited the physician 1-6 times/ year and 15.8% reported disability. Vestibular patients visited the physician 1-8 times/ year and reported disability more frequently (60.8%) (p < 0.01). Among those who worked, 5% of patients with hearing loss and 51% of patients with vestibular disease stopped working during 1-15 cumulative days for the first group and 1-365 cumulative days for the second group. Spearmnan's correlation coefficient between the evolution of the disease and disability days was -0.14 (p < 0.01) for hearing loss patients and -0.27 (p < 0.01 ) for vestibular disease. CONCLUSION: Vestibular disease is a cause of disability. which can have financial impact on both the patient and the health care system.

Discapacidad por enfermedad auditiva y vestibular en un centro de atención especializada / Disability due to auditory and vestibular dysfunction in a specialized care center

Objetivo: identificar la limitación que en su vida diaria padecen los pacientes evaluados por hipoacusia o enfermedad vestibular en un Centro de Atención Especializada del IMSS. Método: participaron 530 pacientes evaluados por primera vez con hipoacusia (n=252) o enfermedad vestibular (n=278), de los cuales eran económicamente activos 54 y 50% respectivamente. Después de la evaluación especializada y de la administración un cuestionario de síntomas co cleovestibulares, se identificó la frecuencia y número de días de discapacidad relacionados con la hipoacusia o enfermedad vestibular y la frecuencia de consultas médicas durante el último año. Resultados: los pacientes con hipoacusia solicitaron consulta médica 1-6 veces/año y 15.8% informaron discapacidad. Mientras que aquéllos con enfermedad vestibular solicitaron 1-8 consultas e informaron discapacidad con más frecuencia (60.8%) (p < 0.01); de los pacientes económicamente activos 5% con hipoacusia y 51% con enfermedad vestibular había tenido discapacidad laboral, de 115 días acumulados para el primer grupo y de 1 365 días para el segundo grupo. La correlación entre el tiempo de evolución de la enfermedad y los días de discapacidad por hipoacusia fue de r de Spearman -0.14 (p < 0.01) y -0.27 (p < 0.01) por enfermedad vestibular. Conclusión. La enfermedad vestibular produce discapacidad, que puede ser prolongada, con implicaciones económicas tanto para el paciente como para la institución que le otorga la atención médica.

Objective: To assess the frequency and characteristics of the disability associated with hearing loss and vestibular disease in a Specialized Medical Center of the Mexican Social Security Institute. Methods: 530 patients agreed to participate. They were assessed due to hearing loss (n=252) and vestibular disease (n=278), 54% and 50% of them worked. After a clinical evaluation and administration of a symptom questionnaire, they were asked about the frequency and days of disability to perform daily life activities related to their audiological or vestibular disease and how often they visited the physician during the last year because of their symptoms. Results: Hearing loss patients visited the physician 1-6 times/ year and 15.8% reported disability. Vestibular patients visited the physician 1-8 times/ year and reported disability more frequently (60.8%) (p < 0.01). Among those who worked, 5% of patients with hearing loss and 51% of patients with vestibular disease stopped working during 115 cumulative days for the first group and 1 365 cumulative days for the second group. Spearman's correlation coefficient between the evolution of the disease and disability days was -0.14 (p < 0.01) for hearing loss patients and -0.27 (p < 0.01 ) for vestibular disease. Conclusion. Vestibular disease is a cause of disability, which can have financial impact on both the patient and the health care system.