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.

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.