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PubMed2004

A prospective trial of sertraline for chronic subjective dizziness.

OBJECTIVES/HYPOTHESIS: The authors previously reported that selective serotonin reuptake inhibitors (SSRIs) reduce chronic subjective dizziness in patients with and without psychiatric illnesses. To extend those preliminary findings and test the hypothesis that SSRIs may offer a novel treatment for chronic subjective dizziness, the authors conducted a prospective study of sertraline in patients with dizziness for more than 6 months, in the absence of active physical neurotologic illness. STUDY DESIGN: Sixteen-week, prospective, open-label, flexible-dose clinical trial. METHODS: Twenty-four patients with subjective dizziness for more than 6 months and no active physical neurotologic illness were studied. Eighteen patients had major anxiety disorders. Six had minor frustration or worry that did not warrant a psychiatric diagnosis. Sertraline was administered at a daily dose of 25 mg, which was increased to a maximum daily dose of 200 mg. Dizziness, functional impairment, and psychological distress were measured using the Dizziness Handicap Inventory (DHI) and Brief Symptom Inventory-53 (BSI-53). Treatment outcomes were analyzed using repeated-measures multivariate analyses of variance, with last observations carried forward. RESULTS: Three patients were excluded from data analysis for disqualifying medical conditions, one for protocol violations. Fifteen (75%) patients completed treatment. Five (25%) withdrew for adverse effects or lack of efficacy. The median daily dose of sertraline was 100 mg. Sertraline significantly reduced scores on all three DHI subscales and the BSI-53. Eleven of 15 (73%) patients who completed treatment had a positive response, including 8 of 11 (73%) with major anxiety disorders and 3 of 4 (75%) with no psychopathological conditions. Six patients enjoyed a full remission of symptoms. CONCLUSION: Sertraline significantly reduced chronic subjective dizziness in patients without active physical neurotologic illness, including those with and without psychiatric comorbidity.

Adult↗
PubMed2003

Change in dizziness handicap after vestibular schwannoma excision.

OBJECTIVE: To evaluate the change in dizziness handicap after translabyrinthine vestibular schwannoma excision. STUDY DESIGN: Prospective administration of the Dizziness Handicap Inventory preoperatively and at 3 and 12 months postoperatively; retrospective review of case notes. SETTING: A tertiary referral neuro-otology clinic. PATIENTS: A total of 100 consecutive patients who had vestibular schwannomas excised between June 1998 and November 2001 and who had completed Dizziness Handicap Inventories preoperatively and at 3 and 12 months postoperatively. INTERVENTIONS: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma; preoperative and postoperative generic vestibular rehabilitation exercises. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory scores. RESULTS: For most patients, dizziness handicap does not worsen postoperatively. However, for those in whom it does, dizziness handicap becomes significantly worse between preoperative and 3-month postoperative time points but then does not continue to decline. Tumor size, sex, and magnitude of preoperative canal paresis significantly affect the degree of change in handicap. Age, the presence of central vestibular system abnormalities, and the nature of the patient's principal presenting symptom have no effect on this handicap change. CONCLUSIONS: These findings help the clinician in counseling the patient preoperatively about dizziness handicap to be expected postoperatively. In particular, the clinician is now able to take an informed and positive stance in the event of a severe canal paresis preoperatively.

Aged↗
PubMed2004

Paroxetine, a selective serotonin reuptake inhibitor, reduces depressive symptoms and subjective handicaps in patients with dizziness.

OBJECTIVE AND STUDY DESIGN: When treating dizzy patients, the psychiatric aspect should be carefully addressed regardless of whether a well-defined organic disease is present. In this prospective study, we aimed to elucidate the role of paroxetine, a selective serotonin reuptake inhibitor, in the treatment of dizziness. SETTING AND PATIENTS: Forty-seven patients who complained of dizziness were treated with 20 mg of paroxetine per day. The depressive state of the patient was evaluated by the Zung Self-Rating Depression Scale (SDS). Treatment outcomes were measured with self-assessment of subjective handicaps in daily life using a dizziness and unsteadiness questionnaire. The questionnaire consisted of five factors related to emotional or bodily dysfunction that could be affected by dizziness. Changes in Self-Rating Depression Scale scores and subjective handicaps were assessed at 4 and 8 weeks after the start of paroxetine. RESULTS: In patients having well-defined organic diseases with high Self-Rating Depression Scale scores, paroxetine improved all five subjective handicap factors as well as Self-Rating Depression Scale scores. The decline in Self-Rating Depression Scale scores showed a significant correlation with improvement of subjective handicaps, which was related to emotional problems but not factors related to bodily dysfunction. Paroxetine was also effective for an improvement of factors related to emotional problems and Self-Rating Depression Scale scores in patients not having organic diseases but with high Self-Rating Depression Scale scores. In patients either with or without organic diseases with low Self-Rating Depression Scale scores, paroxetine had no effect on any subjective handicap factors and Self-Rating Depression Scale scores. CONCLUSION: In the treatment of dizzy patients, paroxetine was effective at relieving subjective handicaps caused by dizziness, specifically, in patients with high Self-Rating Depression Scale scores.

Activities of Daily Living↗
PubMed1994

Dizziness in elderly men.

OBJECTIVE: To evaluate the causes of dizziness in elderly men. DESIGN: A descriptive study involving the clinical and laboratory features of elderly men with dizziness. SETTING: A university-affiliated Veterans Affairs medical center. PATIENTS: One hundred seventeen consecutive men more than 50 years of age attending a general neurology clinic with the chief complaint of dizziness. RESULTS: The median duration of dizziness at first office visit was 45 weeks. Forty-nine percent of patients had more than one diagnosis that contributed to their dizziness. Dysfunctions of the peripheral vestibular system were found in 71% and were the principal causes in 56%. Benign positional vertigo was present in 34%. Disorders of the visual system were found in 26% but were the major cause in only 1%. Diagnoses involving the proprioceptive system were present in 17% and were the principal cause in 7%. Structural lesions of the brainstem or cerebellum or metabolic disorders that affected normal brainstem function were identified in 59% and were the major diagnoses in 22%. A psychophysiologic diagnosis was made in 6% but was the major diagnosis in only 3%. At the 6-months follow-up, 55% of patients improved, 34% were unchanged, 4% worsened, and 7% were lost to follow-up. CONCLUSIONS: Contrary to reports in the literature, dizziness in the elderly is more persistent, has more causes, is less often due to a psychophysiologic cause, and seems to be more incapacitating than dizziness in younger patients.

Age Factors↗
PubMed2000

Health, functional, and psychological outcomes among older persons with chronic dizziness.

OBJECTIVE: The recommended clinical strategy for a health condition should depend both on the known causes of and outcomes associated with the condition. The aim of this study was to determine the range of adverse outcomes associated with chronic dizziness. DESIGN: Population-based prospective cohort study. SETTING AND PARTICIPANTS: A probability sample of 1087 persons, age 72 and older, living in the community. MEASUREMENTS: The following were measured: chronic dizziness, death, hospitalizations, falls, syncope, basic and instrumental activities of daily living, depressive symptoms, self-rated health, falls self-efficacy, and social activities. RESULTS: Of the 1087 participants, 261 (24%) reported chronic dizziness. Over 1 year of follow-up, chronic dizziness was not associated with mortality, hospitalization for any reason, or change in basic or instrumental activities of daily living, but was associated with risk of falling (unadjusted relative risk [RR] 1.35; 95% confidence interval [CI] 1.06-1.72) and with experiencing syncope (RR 2.31; 95% CI 1.24-4.30). After adjustment for baseline level, chronic dizziness also was associated with worsening of depressive symptoms, self-rated health, falls efficacy, and social activities. The relationship remained significant, after adjustment for potential confounding factors, for self-rated health (T-statistic -2.95, P = .003) and falls efficacy (T-statistic -2.68; P = .008), and was of marginal significance for depressive symptoms (T-statistic -1.73; P = .085). CONCLUSIONS: These results suggest that the goals of care for older persons with chronic dizziness should be redirected from solely identifying and treating discrete diseases--an often expensive and unrewarding task--toward reducing the symptoms of chronic dizziness and alleviating the resulting physical, psychological, and social disability.

Accidental Falls↗
PubMed1998

Neuro-otological and psychiatric abnormalities in a community sample of people with dizziness: a blind, controlled investigation.

OBJECTIVES: To determine neurootological and psychiatric abnormalities associated with complaints of dizziness in an epidemiological community sample of people of working age, and the extent of comorbidity between neuro-otological and psychiatric dysfunction. METHOD: A survey of 3884 people randomly selected from six general practice lists identified 262 people with significant dizziness, from which a subsample of 15 men and 22 women were recruited for testing. Dizzy subjects were evaluated by blind neuro-otological testing, computerised dynamic posturography, a computerised psychiatric assessment, neuro-otological and general medical examination, and diagnosis. An age matched control group of 18 men and 22 women underwent the same evaluation. RESULTS: Tests of auditory, vestibular, and oculo-motor function did not discriminate between dizzy subjects and controls, but dizzy subjects had significantly worse balance on posturographic testing, more diagnoses of medical disorder, and a higher prevalence of psychiatric morbidity. CONCLUSIONS: The findings suggest that dizziness in the community is typically characterised by mild physical disorder accompanied by some psychiatric disturbance. As the combination of minor physical and psychiatric disorder is known to be unusually persistent and handicapping, treatment programmes must be provided for this prevalent syndrome, perhaps by a partnership between primary care and neuro-otological and psychiatric hospital outpatient clinics with experience and expertise in the diagnosis and management of dizziness and psychiatric disturbance.

Adolescent↗
PubMed1991

Clinical significance of a dizziness history in medical patients with syncope.

To determine the implications of dizziness as a symptom in patients with syncope, we analyzed responses to a standardized battery of questions about dizziness in 121 consecutive patients referred for evaluation of syncope. Associations were sought between final diagnosis (dependent variable) and clinical predictor variables. Dizziness was found in 70% of the patients with syncope. Dizzy patients were younger (mean ages, 47 vs 56 years, respectively), more often female (75% vs 42%), and more likely to be assigned a psychiatric diagnosis. Multivariable logistic regression analysis identified young age and rotatory dizziness (vertigo) to be associated with a psychiatric diagnosis. Dizziness and syncope frequently coexist and in many cases may represent the same pathophysiologic process. A careful dizziness history may guide the initial evaluation of syncope patients in clinical practice.

Adolescent↗
PubMed1976

[Differential diagnosis of dizziness (author's transl)].

The common denominator of the different meanings of dizziness is a disturbance of spatio-postural orientation, which indicates an imminent danger of fall. Höhenschwindel (fear of hights) with grasping and holding in the primate is instinctive behavior caused by a visual cliff or sudden dizziness. Because of the many possible meanings of dizziness, the case history is important for differential diagnosis. Vertiginous and non-vertiginous dizziness, black out and unsteady gait without vertigo should be distinguished. In addition, the duration and time course of the attack, releasing mechanisms and accompanying symptoms of dizziness should be explored. In recurrent dizziness without hearing loss, vestibular, vascular, cardial and epileptic disorders should be considered as well as intoxication, cerebral tumor, cerebellar hemangioblastoma, multiple sclerosis, neurosis and psychosis. Epileptic dizziness occurs not only in the prodromal stage of grand mal attacks and in temporal lobe epilepsy, but also in petit mal absences of short duration (less than 5 s) in which the blurring of consciousness is not apparent; absences of short duration are easily overlooked in childhood. Besides the objective history obtained from the patient's relatives, EEG-recording when falling asleep in the morning after one night of sleep deprivation are the best means for the diagnosis of epilepsia. Spontaneous nystagmus after complete exclusion of visual fixation is a physiological phenomenon. For differential diagnosis between physiological and pathological spontaneous nystagmus, Frenzel's spectacles in the dark room are indispensable. The distinction of spontaneous nystagmus in the narrower sense, gaze nystagmus and fixation nystagmus is discussed. The diagnostic importance of the direction of nystagmus is mentioned. Jerking nystagmus may be congenital. Pendular nystagmus may be acquired. Therefore, additional criteria for the differential diagnosis between congenital and acquired nystagmus are necessary.

Alcoholism↗
PubMed2004

Outcome after mild to moderate traumatic brain injury: the role of dizziness.

OBJECTIVE: To assess the specific effect of dizziness on psychosocial outcome after mild to moderate traumatic brain injury (TBI). DESIGN: Six-month cross-sectional study. Setting An outpatient TBI clinic in a tertiary care referral center. Participants A consecutive sample of 207 adults with mild to moderate TBI, 138 (66.7%) of whom had subjective complaint of posttraumatic dizziness. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Psychosocial indices (Glasgow Outcome Scale [GOS], General Health Questionnaire [GHQ], Rivermead Head Injury Follow-Up Questionnaire [RHFUQ], return to work status) were collected from dizzy and nondizzy patients. RESULTS: Despite similar demographic, TBI, and global disability (GOS) profiles of both groups, psychosocial functioning (GHQ, RHFUQ, return to work) was significantly worse in dizzy subjects ( P <.01 for all indices). A logistic regression analysis identified dizziness ( P =.006), total GHQ ( P =.001), and psychotropic and analgesic use ( P =.05) as significant independent predictors of reemployment. CONCLUSIONS: Although dizziness was closely linked to psychologic distress at 6 months after head injury, it also emerged as an independent predictor of failure to return to work, suggesting that not all its adverse effects on outcome are psychologically mediated. Clinicians need to be alert to the presence of dizziness as an adverse prognostic indicator after mild to moderate TBI.

Adult↗
PubMed1996

Development of an inventory for dizziness and related factors.

Dizziness is an extremely common complaint of patients, yet often goes unexplained after medical evaluation, which can lead to inappropriate treatment. There is a lack of psychometrically sound self-report instruments that measure dizziness and related factors. This study describes the application of factor analytic procedures with 184 dizzy patients' responses to develop the Dizzy Factor Inventory (DFI), a 44-item inventory divided into three sections and modeled after the Multidimensional Pain Inventory. The first section consists of symptom factors, the second concerns responses of significant others to the dizzy patient, and the third section assesses activity level. This inventory groups symptoms into empirically distinct factors that could be related in clinical and research applications to physiological and psychological processes, and could be useful for treatment planning and measuring treatment progress. Factors derived with dizzy patients are compared to factors found with chronic pain patients.

Activities of Daily Living↗
PubMed1998

[Prescription drugs, dizziness and accidental falls in hospital patients over 75 years of age].

The review of medication has been recommended as an important part in preventing falls. In a random sample of 276 hospital in-patients aged 75 and over, the frequency of prescribed drugs which may increase the risk of falling by causing dizziness was assessed. Questions about dizziness and previous falls were included in a standardized questionnaire. Patients with dizziness reported falls 10 times more often than patients without dizziness. Prescribed medications possibly causing dizziness were very common. Neuroleptics, antidepressants, hypnotics/sedatives, and combinations of drugs with hypotensive efficacy were significantly more often prescribed in patients who reported dizziness. Systematical review of medications appears to be worthwhile, particularly in cases with multiple drug prescriptions.

Accidental Falls↗
PubMed2006

Is psychogenic dizziness the exact diagnosis?

The main goal of the study is to determine the exact ratio of pure psychogenic dizziness. Patients from vertigo outpatient clinic were evaluated by SCL-90 R questionnaire, interviews, vestibular tests and magnetic resonance imaging (when needed). Five hundred and eighteen patients were evaluated for this study. While 45.2% of the patients have at least one abnormal psychogenic scale (somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety etc.), only 9% of the patients were diagnosed as psychogenic dizziness according to the interview. One percent of 518 had no organic cause for dizziness and also diagnosed as pure psychogenic dizziness. Our results suggest that patients with dizziness need to be evaluated by psychological tests routinely and patients with high-test scores must consult a psychiatrist who is familiar with dizziness symptomatology.

Dizziness↗
PubMed2006

Cervical vertigo and dizziness after whiplash injury.

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.

Adult↗
PubMed1994

Symptoms as a clue to otologic and psychiatric diagnosis in patients with dizziness.

Dizziness is a common symptom that often remains unexplained despite extensive medical evaluation. Psychiatric disorders are usually considered only after all medical causes of dizziness have been ruled out. Sixty-five patients referred to an otolaryngology practice received a structured psychiatric interview, an otologic evaluation, and a dizziness questionnaire modified to assess psychiatric symptoms. They were divided into four diagnostic groups: psychiatric diagnosis only, otologic diagnosis only, both diagnoses, or neither diagnosis. Eleven questionnaire items were significantly associated with diagnostic groupings. Stepwise discriminant function analysis utilizing age, gender, rapid/irregular heartbeat, extremity weakness, nausea/vomiting, and difficulty with speech resulted in correct group classification for 70% of subjects. The presence of dizziness symptoms like vertigo or lightheadedness was not significantly different between groups. This study suggests that assessment of psychiatric and autonomic symptoms should accompany, not follow, otologic evaluation of dizziness. These symptoms may be more important diagnostically than dizziness quality.

Adult↗
PubMed1994

ED length-of-stay and illness severity in dizzy and chest-pain patients.

Emergency department (ED) length of stay, illness severity, and patterns of ED-based testing can be used to compare different ED patient populations. To assess the relative significance of ED patients with dizziness and chest pain in emergency medicine practice, the investigators formed a retrospective chart review of 3,864 adults (age > or = 16 years) seen at the University of North Carolina Hospitals' ED during May and June of 1991. Patients were eligible if they had any complaint of dizziness (n = 259), nontraumatic chest pain (n = 168), or both (n = 18). ED length of stay and illness severity, as measured by Acute Physiology and Chronic Health Evaluation (APACHE) II score, were not significantly different between the two groups. Dizzy and chest-pain patients were both high users of ED-based testing, but management patterns were different. Chest-pain patients were more likely to undergo electrocardiogram and x-ray testing, whereas dizzy patients more often received testing such as brain computed tomography scanning (10.8% v 3.6%, P = .01). ED patients with dizziness and chest pain were similar with regard to ED length of stay. Given their overall similarities to the chest-pain group, dizzy patients appear to represent a significant population of ED patients and may warrant more clinical study.

Adult↗
PubMed2004

Intracranial blood flow velocities and CO2 reactivity in diagnosing migraine-related dizziness.

OBJECTIVE: Migraine-related dizziness can present with or without headache, often making diagnosis difficult. Flow velocity and CO 2 reactivity testing using transcranial Doppler (TCD) measurement of intracranial blood flow has been described as abnormal in patients with classic or common migraine. This study sought to determine the utility, if any, of this noninvasive technique in the diagnosis of migraine-related dizziness. STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology and neurology practices was conducted. Nine patients with migraine-related dizziness and 10 patients with no history of migraine or dizziness were tested with transcranial Doppler ultrasound in a blinded fashion. RESULTS: No statistically significant differences in intracranial blood flow velocities or in cerebrovascular reactivity to hypocapnia were found between patients and controls. CONCLUSIONS: Assessment of intracranial blood flow velocity and CO 2 reactivity using TCD does not help in the diagnosis of migraine-related dizziness. SIGNIFICANCE: A reliable objective test for the diagnosis of migraine-related dizziness remains elusive, and the diagnosis of this patient group continues to be suboptimal.

Adult↗
PubMed2000

Experience from a multidisciplinary "dizzy" clinic.

OBJECTIVE: To describe the experience of a combined otolaryngology and neurology multidisciplinary clinic in the evaluation, investigation, and management of patients with dizziness. STUDY DESIGN: Prospective clinical study. SETTING: Patients were seen in a tertiary referral, multidisciplinary clinic at The Toronto Hospital, University of Toronto, Ontario, Canada. INTERVENTION: A thorough history, formal otoneurologic examination, and appropriate laboratory investigations were performed. After their assessment, the patient's diagnoses were classified as peripheral, central, psychogenic, or undiagnosed and were then subdivided into specific clinical diagnoses. RESULTS: The first 812 consecutive patients seen in the multidisciplinary clinic from January 1, 1993 to December 31, 1998 are reported. Five hundred twenty-five (64.7%) patients were found to have a peripheral vestibular cause for their dizziness, 66 (8.1%) had a central cause, 108 (13.3%) had a diagnosis unknown, and 73 (9.0%) were thought to be psychogenic. In 40 (4.9%) patients, a peripheral and central cause were found. More than one type of peripheral disorder was noted in 17.9% of patients with a peripheral vestibular cause for their dizziness, and 12.3% of patients with a central cause for their dizziness had more than one specific type of central nervous system disorder. CONCLUSIONS: Most patients that were seen in a multidisciplinary clinic had a peripheral vestibular disorder. Central causes of dizziness were relatively uncommon. Serious diseases such as tumor, multiple sclerosis, and encephalitis were rare and unlikely to present with dizziness only. It is important to realize that a patient may have more than one type of disorder accounting for the symptoms, which may represent a spectrum of disease affecting the inner ear.

Adolescent↗
PubMedDate not supplied

Correlation between dizziness and impaired glucose metabolism.

INTRODUCTION: Impaired glucose metabolism is characterized by conditions of hypo and hyperglycemia. AIM: The objective of the present study was to asses whether or not there is a relationship between impaired glucose metabolism and dizziness. In the clinical laboratory settings, patients were examined using vectoelectronystagmography in association with glycemic levels. METHODS: 33 patients were divided in 3 groups: diabetics; patients with dizziness and a control group. RESULTS: 65% of the patients with dizziness showed impaired glucose metabolism. 40% of the patients with dizziness had alterations in their vectoelectronystagmography results. CONCLUSION: Dizziness is a good indicator of glucose metabolism alterations and these may be a good indicator of alterations in vectoelectronystagmography responses. The study of glycemic levels after glucose overexposure is a good prognosis factor to evaluate dizziness and shows the same results as insulin level studies after glucose overexposure.

Adult↗