Introduction to the assessment and management of persistent postural-perceptual dizziness.

OBJECTIVE: Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments. METHOD: Literature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis. RESULTS: Research has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance. CONCLUSION: Management utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.

Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms.

OBJECTIVE: Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms. STUDY DESIGN: Prospective cohort analysis of 52 patients with vestibular migraine (VM). SETTING: Tertiary referral center. PATIENTS: Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria. INTERVENTIONS: Subjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis. MAIN OUTCOME MEASURES: Pearson correlation coefficient, R2 value. RESULTS: VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression ( R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness ( p < 0.001). CONCLUSIONS: Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.

Assessment of sleep quality in fibromyalgia syndrome and its effect on postural balance and functional status.

BACKGROUND: Patients with fibromyalgia syndrome (FMS) often have sleep problems and balance disorders. OBJECTIVE: The aim of the study was to examine sleep quality and balance disorders and the relationship between sleep quality and balance, functional status and the frequency of falls in patients with FMS. METHODS: Fifty women with FMS and 50 healthy women were included in the study. Sleep quality was assessed with the numeric rating scale (NRS) and the Pittsburgh Sleep Quality Index (PSQI) and balance and balance self-confidence were assessed with the Berg Balance Scale (BBS) and Activities-Specific Balance Confidence (ABC) Scale, respectively. Functional status and symptom severity of patients were assessed with the Fibromyalgia Impact Questionnaire (FIQ) and the Symptom Impact Questionnaire (SIQR). The number of falls in the last six months were recorded. RESULTS: In the patient group, sleep quality scores were significantly higher, and BBS and ABC scores were significantly lower than the control group. NRS scores were significantly correlated with the BBS, FIQ, and SIQR scores, and the PSQI scores were significantly correlated with the BBS and ABC scores and the number of falls in FMS. CONCLUSION: This study showed that the prevalence of sleep and balance disorders is higher in FMS patients. A relationship was reported between the sleep quality and balance and functional status and frequency of falls.

The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant.

OBJECTIVES: The pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. METHODS: The test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. RESULTS: Complete data from 35 children, all CI candidates, age ranging 4-79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests' disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. CONCLUSIONS: The search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.

Reliability and Concurrent Validity of Life Space Assessment in Individuals With Vestibular Disorders.

BACKGROUND AND PURPOSE: The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this study was to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders. METHODS: One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12). RESULTS: The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (ρ = -0.326, P < 0.01), DHI physical subscore (ρ = -0.229, P = 0.02), DHI functional subscore (ρ = -0.406, P < 0.01), and DHI emotional subscore (ρ = -0.282, P < 0.01). The LSA was positively correlated with both the physical (ρ = 0.422, P < 0.01) and mental (ρ = 0.362, P < 0.01) composite scores of the SF-12. DISCUSSION AND CONCLUSIONS: Similar to the findings in community-dwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A317).

Threat assessment and locomotion: clinical applications of an integrated model of anxiety and postural control.

Interactions between anxiety and vestibular symptoms have been described since the late 1800s. Typically, they have been conceptualized as bidirectional effects of one condition on the other (i.e., anxiety disorders as a cause of vestibular symptoms and vestibular disorders as a cause of anxiety symptoms). Over the past 30 years, however, a steady progression of neurophysiological investigations of gait and stance under conditions of postural threat, neuroanatomical studies of connections between threat assessment and vestibular pathways in the brain, and clinical research on anxiety-related vestibular conditions has offered the building blocks of a more integrated model. In this newer concept, threat assessment is an integral component of spatial perception, postural control, and locomotion in health and disease. It is not imposed on the vestibular system from the outside or simply reactive to vestibular dysfunction, but an inherently necessary part of every aspect of mobility. In this article, the authors review evidence that supports this model and then use it to examine common neurotologic conditions in which anxiety-related processes play important roles-fear of falling, primary and secondary anxiety disorders in patients with vestibular symptoms, and chronic subjective dizziness.

Neurocognitive measures in the assessment of vestibular disturbance in patients with brain injury.

INTRODUCTION: Problems with balance and dizziness are one of the most common complaints of individuals who have experienced a brain injury and are reported in up to 90% of cases. Despite the ubiquity of vestibular disturbance in this population, there remains a dearth of research on the interaction between physiological and cognitive systems responsible for maintaining balance. PURPOSE: The purpose of this article is to review studies on the interaction of physiological and cognitive processes required to maintain balance that may aide assessment and recovery of balance disturbance in patients with brain injury. SUMMARY: This article provides a review of research on the role of higher order cognitive processes in maintaining balance and rational for further inclusion of neurocognitive measures in the assessment of vestibular disturbance. CONCLUSION: Greater inclusion of neurocognitive measures in assessment of vestibular disturbance provides a method of assessment containing increased ecological validity compared to traditional assessments, better prepares patients for discharge, and may reduce the incidence of future injury.

Vestibular end-organ dysfunction in children with sensorineural hearing loss and cochlear implants: an expanded cohort and etiologic assessment.

INTRODUCTION: Similarities between the peripheral auditory and vestibular systems suggest that children with sensorineural hearing loss (SNHL) may demonstrate associated vestibular impairments. The current study examines vestibular function in a previously reported cohort (n = 40) augmented by 113 children with profound SNHL. METHODS: The current study is prospective and cross-sectional with repeated measures. Horizontal canal function was assessed in response to caloric and rotational stimuli. Saccular function was examined using vestibular evoked myogenic potentials (VEMP). One hundred fifty-three children were tested; 119 had unilateral cochlear implants (CIs) at time of testing, and 34 were evaluated before CI. RESULTS: Horizontal semicircular canal function was abnormal in response to caloric stimuli in 50% (69/139), with a proportion (18/69, 26%) reflecting mild to moderate unilateral abnormalities. Severe hypofunction or areflexia occurred in 37% (51/139). Horizontal semicircular canal function in response to rotation was abnormal in 47% (64/139). Bilateral reduction in VOR gain was seen across frequencies in 29% (40/139) and 13% (18/139) demonstrated isolated high-frequency (≥ 2 Hz) loss. Saccular function was absent bilaterally in 21% (32/135) and unilaterally in 30% (40/135). All children with meningitis (n = 11) and 46% with radiologic cochleovestibular anomalies (n = 31) had horizontal canal dysfunction, whereas 45% and 46%, respectively, displayed saccular dysfunction. Unilateral dysfunction of the horizontal canal or the saccule was equally distributed between the implanted and nonimplanted ear (14:9 and 22:18, respectively), and the differences in proportions were not statistically significant. CONCLUSION: Vestibular end organ dysfunction occurred in half of all children with profound SNHL. Approximately one-third of the subjects displayed severe abnormalities(bilateral and/or severe loss). The likelihood of vestibular end-organ dysfunction is highly dependent on etiology, with meningitis and cochleovestibular anomalies having the highest rates of severe dysfunction.

Peripheral vestibular system in Down syndrome: quantitative assessment of vestibular histopathology.

OBJECTIVE: To evaluate the maturity of the peripheral vestibular system in Down syndrome by examining the number of Scarpa's ganglion cells and the density of vestibular hair cells. STUDY DESIGN: Case-control study using human temporal bones. SETTING: Tertiary academic center, otopathology laboratory. SUBJECTS AND METHODS: Sixteen temporal bones from 8 patients with Down syndrome and 15 control temporal bones from 8 individuals with no history of otologic disease were selected. Hypoplasia of the lateral semicircular canal (LSC) and vestibule was investigated by measuring the dimensions of the structures. Scarpa's ganglion cells were counted under light microscopy. The vestibular hair cells were counted in the LSC crista and the utricular and saccular maculae under differential interference contrast (Nomarski) microscopy and expressed as density. RESULTS: The patients with Down syndrome were divided into 2 groups: with and without LSC hypoplasia. The number of Scarpa's ganglion cells and the density of vestibular hair cells were significantly smaller in both groups of patients with Down syndrome than in the control group. There was no significant difference in the number of Scarpa's ganglion cells or the density of vestibular hair cells between the groups with and without LSC hypoplasia. CONCLUSION: The peripheral vestibular system, including Scarpa's ganglion cells and vestibular hair cells, is hypoplastic irrespective of the vestibular malformation in Down syndrome.

Developmental profile and trajectory of neuropsychological skills in a child with Kabuki syndrome: implications for assessment of syndromes associated with intellectual disability.

Kabuki syndrome (KS) is a rare genetic syndrome involving dysmorphic facial features,and reports of intellectual disability (ID). We examined the developmental trajectory of neuropsychological skills in a child with KS (seen at ages 4, 6, 7, 9, and 11). Examination of raw and age-corrected standard scores suggests that language-based skills developed appropriately, but visually based skills slowed and reached a plateau. Executive dysfunction and mood symptoms were also observed. While ID is described as a core feature of KS,some patients may not meet diagnostic criteria for ID, and may be better described as having specific deficits in nonverbal skills. Longitudinal neuropsychological assessment of children with KS and other syndromes associated with ID is warranted to understand the true prevalence of ID versus isolated cognitive impairments.

Geriatric vestibulopathy assessment and management.

PURPOSE OF REVIEW: This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals. RECENT FINDINGS: Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60-69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling. SUMMARY: When caring for an older dizzy patient always assess medication use, perform a Dix-Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation.

Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies.

Superior semicircular canal syndrome (SSCS) includes vestibular and audiological symptoms which result from the introduction of a third mobile window into the osseous cochlea. Surgical repair is considered in cases of incapacitating symptoms. The present paper aims at comparing the different surgical approaches and modes of dehiscence repair, regarding their respective efficacy and potential pitfalls. A systematic literature review and meta-analysis of pooled data were performed. Study selection included prospective- and retrospective-controlled studies, prospective- and retrospective-cohort studies, ex vivo studies, animal models, case-reports, systematic reviews and clinical guidelines. A total of 64 primary operations for SSC repair were identified; 56 ears were operated for vestibular and 7 for auditory complaints. A total of 33 ears underwent canal plugging, 16 resurfacing, and 15 capping. Success rates were 32/33, 8/16, and 14/15, respectively. The observed differences were statistically significant (P=0.001). Resurfacing proved less effective than both plugging (P=0.002), and capping (P=0.01) techniques. Temporalis fascia was commonly used as sealing material and was combined with bone-pâté/bone-wax (plugging), bone-graft (resurfacing), or hydroxyapatite-cement (capping). Most operations were performed via middle-fossa approach; higher success rates were associated with plugging and capping techniques. SNHL and disequilibrium were the most frequent complications encountered. Most cases were followed for 3-6 months. Precise criteria regarding follow-up duration and objective success measures are not determined. Surgical repair of SSCS is considered as a valid therapeutic option for patients with debilitating symptoms. Consensus regarding strict follow-up criteria and objective assessment of success is necessary before larger scale operations can be implemented in clinical practice.

Development and assessment of the vestibular system.

Paediatric vestibular assessment is necessary in various situations, yielding invaluable information relating to diagnoses and allowing for the formulation of appropriate rehabilitative strategies when considering the management of children with vestibular and balance problems, alone or in association with hearing impairment or other developmental disorders. The development and assessment of the vestibular system is considered in this article.

Symptoms of detachment from the self or from the environment in patients with an acquired deficiency of the special senses.

To compare the frequency of symptoms of detachment from the self or from the environment (DD) in patients with an acquired deficiency of the special senses, a questionnaire for DD symptoms [12] and the GHQ12 questionnaire for common mental disorders [16] were auto-administered to patients with hearing-loss (N = 40), peripheral vestibular disease (N = 40) or bilateral retinal disease (N = 40), and to 80 healthy subjects. Patients with retinal disease and patients with vestibular disease reported DD symptoms more frequently & severe than patients with hearing loss and healthy subjects. DD scores were related to the GHQ12 scores and to the type of sensory dysfunction. DD symptoms are more frequent & severe in patients with an acquired deficiency of the special senses, associated to symptoms of common mental disorders.

Effects of fluvoxamine on anxiety, depression, and subjective handicaps of chronic dizziness patients with or without neuro-otologic diseases.

A prospective, open-label clinical trial was conducted for two aims: first, to evaluate the role of fluvoxamine, one of selective serotonin reuptake inhibitors, in the treatment of dizziness for the first time and to investigate its effective mechanisms. Second, to test the hypothesis that dizziness in patients without abnormal neuro-otologic findings would be induced by psychiatric disorders rather than by unnoticed neuro-otologic diseases. Nineteen patients with neuro-otologic diseases (Group I) and 22 patients in whom standard vestibular tests revealed no abnormal findings (Group II) were treated by fluvoxamine (200 mg/day) for eight weeks. Subjective handicaps due to dizziness using a questionnaire, anxiety and depressive symptoms measured with the Hospital Anxiety and Depression Scale (HADS), and stress hormones (vasopressin and cortisol) were examined before and 8 weeks after treatment. Overall, fluvoxamine decreased subjective handicaps of both Groups I and II. Fluvoxamine decreased HADS of only patients whose subjective handicaps were reduced (=responders) in both groups, suggesting that fluvoxamine was effective for dizziness via psychiatric action rather than a recovery of vestibular function through serotonergic activation. In non-responders of Group II, pre-treatment HADS was higher than in Group I non-responders and it was not decreased by the treatment, suggesting that dizziness of Group II non-responders was due to severe psychiatric disorders rather than unnoticed neuro-otologic diseases. Anxiety and depression components of HADS showed a good correlation at both pre- and post-treatment periods. No post-therapeutic decrease was observed in either vasopressin or cortisol even in responders, suggesting that dizziness was not the sole cause of stress in chronic dizziness patients. In conclusion, patients with or without physical neuro-otologic deficits who report chronic dizziness accompanied by anxiety and depression (as measured by HADS) showed improvements across a full range of subjective handicaps and psychological distress, while patients with physical neuro-otologic defects and minimal anxiety or depression did not benefit. The main causes of dizziness in patients without physical neuro-otologic findings were psychiatric disorders.

The assessment of increased sensitivity to visual stimuli in patients with chronic dizziness.

Patients with chronic vestibular dysfunction often experience visually-induced aggravation of dizzy symptoms (visual vertigo; VV). The Situational Characteristics Questionnaire (SCQ), Computerized Dynamic Posturography or Rod and Frame Test (RFT) are used to assess VV symptoms. This study evaluates whether correlations exist between these three tests, their ability to identify patients with VV and whether emotional state correlates with VV symptoms. Tests were completed by 20 normal controls (Group NC), 20 patients with vestibular dysfunction plus VV (Group VV) and 13 without VV (Group NVV). Additionally, the Vertigo Symptom Scale (VSS-V) was applied to quantify general, non-visually induced vertigo (dizziness, lightheadedness and/or spinning) and imbalance. Autonomic (VSS-A) and psychological symptoms (Hospital Anxiety and Depression questionnaire; HAD) were also assessed. With the SCQ 100% of Group VV scored outside normal ranges and scores differed significantly between Group VV and both Groups NC and NVV. RFT values were not significantly different between groups; only 15% of patients scored outside normal ranges. Posturography scores were abnormal for 50% of patients; significant differences were noted between Groups NC and VV for composite scores and ratios 3/1, 4/1, 5/1 and 6/1 (indicative of abnormal sensory re-weighting). There were no correlations between the three data sets in patients. Anxiety and depression scores significantly differed between Groups NC and VV but not between patient groups; this indicates that psychological symptoms may be present in either patient group. The SCQ can be used to corroborate an initial clinical diagnosis of VV and quantify its severity in patients with vestibular dysfunction. Posturography data suggested patients with VV have a sensory re-weighting abnormality. The rod and frame test results and posturography findings agree less with the clinical diagnosis of VV. Psychological symptoms may need to be addressed.

[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.