uidetti G

Psychological distress and disability in patients with vertigo

OBJECTIVE Vertigo is an extremely debilitating experience for the patient, especially during attacks; it is neither easy to identify nor control. The importance of psychosomatic factors has already been widely studied and discussed. In particular, it has been shown that stress factors are relevant in setting off episodes of dizziness, but there is no agreement if the presence of distress might influence the vestibular disability. METHODS This study is concerned with evaluating the quality of life (QOL) in a group of 206 patients suffering from vertigo and 86 control patients, using the UCLA-Dizziness Questionnaire (UCLA-DQ) scale. The results were correlated with those achieved using the Hospital Anxiety and Depression Scale (HADS) psychometric test. RESULTS What is clear is that, in patients suffering from vertigo as regards those who are not, there is a significant amount of anxiety and depression distress, especially in female subjects. There appears to be no relationship between psychological change and the various forms of clinical vertigo. In terms of the QOL parameter, what emerges is that, from a statistical point of view, fear of becoming dizzy is most closely correlated with the perception of disability. CONCLUSIONS There is a also a need for psycho-education here in collaboration with the E.N.T. specialist so that the patient can learn to recognise his/her medical condition and be aware of the factors that primarily contribute to the deterioration of their QOL.

Psychosomatic Study of 60 Patients with Vertigo

The authors examined 60 consecutive patients hospitalized in Modena University Otorhinolaryngological Clinic for vertigo by means of an interview and of three self-rating scales (Zungs SDS, SAS and the Middlesex Hospital Questionnaire). The control group was composed of an equal number of patients hospitalized in the same ward and period for different nonsurgical otiatric diseases; the two groups were matched for age, sex, residential area, sociocultural conditions, duration of hospitalization and disease. According to the clinical diagnosis carried out when discharged from hospital, the patients where divided into five groups (Ménières disease, neuronitis, vertebrobasilar insufficiency, neurosensorial deafness, nucleoreticular syndrome of Ararslan). The data regarding depression (MHQ and SDS), anxiety (MHQ and SAS), neuroticism, somatization (MHQ) and the prevailing of hysterical personality traits in women (MHQ) resulted particularly relevant from a statistical viewpoint (p less than 0.01).

The Recurrences of Paroxysmal Positional Vertigo

Paroxysmal positional vertigo (PPV) is one of the most frequent types of true objective dizziness. Progress in the knowledge of the pathogenetic mechanisms of PPV and, still more, the excellent results obtained in the last 20 years with the liberatory or repositioning manoeuvres have created much enthusiasm for the possibilities of resolving this disease. Many factors, however, make it difficult to appraise the incidence, prevalence and spontaneous evolution of PPV in a vast sample of cases or in well determined territories. In any event it is evident that the natural course of PPV is not the same in all patients and it may be influenced by different factors.

Paroxysmal positional vertigo and labyrintholithiasis: certainties and doubts

Paroxysmal positional vertigo (PPV) is a vestibular disorder with a high prevalence in the general population, so common that it may be considered as one of the most – or even the most frequent type of true dizziness. It was described many years ago (Adler, 1897) and its clinical aspects have been more and more refined to describe a nosological entity universally recognised. The focus on PPV has grown with the introduction of the so-called repositioning and liberatory manoeuvres. These manoeuvres have provided effective therapeutical instruments for this common pathology which is severely disturbing and non-responsive to pharmacological therapy even when symptomatic. Their unquestionable efficacy has solved the frustration of the clinician not to be able to treat PPV and has created great scientific and clinical enthusiasm regarding this topic. This enthusiasm has favoured new research, thanks to which many aspects of PPV are now considered undebatable. Other aspects require more study and reflection. The certainties concern most of all the clinical aspects, diagnosis and therapy. The pathogenesis, the aetiology, the causes and therapy of recurrences, are the more uncertain topics. More than 10,000 cases of PPV that I personally treated in the last 20 years have stimulated my own reflections. In my opinion many aspects are still controversial, but I think that the doubts and reflections here presented can stimulate other discussions and improve knowledge of PPV, helping to find a more effective therapy for the most atypical or unresponsive cases.