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Why Does Vertigo Become Chronic After Neuropathia Vestibularis?

From the Department of Psychiatry, Free University of Berlin, Berlin, Germany.

Address correspondence and reprint requests to Frank Godemann, MD, Department of Psychiatry and Psychotherapy, Charité Hospital, Humboldt University at Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany. E-mail: f.godemann{at}alexius.de

OBJECTIVE: Vertigo is one of the most frequent complaints in general medical practice and is often linked to psychiatric disorders. A longitudinal study of 67 patients with an acute vestibular disorder was undertaken to clarify if, after experiencing acute vestibular vertigo, certain patients have a higher likelihood of developing chronic, debilitating dizziness despite no evidence of a damaged peripheral vestibular system.

METHOD: The severity of dizziness was determined in 67 patients with vestibular neuronitis, 6 months after their release from hospital, using the Vertigo Symptom Scale from Yardley et al. The intensity of anxiety directly after vertigo was experienced, body-related cognitions, illness coping, personality structure, and the recovery of the organ of equilibrium were recorded in order to explain the severity of vertigo that occurred after 6 months. The function of the organ of equilibrium was assessed by using a caloric test.

RESULTS: Over a period of 6 months, 13 of the 67 patients (19.4%) reported continuing dizziness after neuropathia vestibularis. Eleven of the 13 patients showed high scores on a scale for measuring vertigo-related symptoms, which can be interpreted as being equivalent to anxiety. The variables of gender, catastrophic thoughts and a dependent personality accounted for 35% of why vertigo became chronic.

CONCLUSION: Neuropathia vestibularis represents a risk factor for the development of chronic vertigo. Chronic vertigo after neuropathia vestibularis appears to be equivalent to anxiety and is partly conditional on catastrophic thoughts at the beginning.

Key Words: neuropathia vestibularis, • chronic vertigo, • psychogenic vertigo, • risk factors.

Abbreviations: DIPS = Diagnostic Interview of Psychiatric Diagnoses;; VSS = Vertigo Severity Scale;; SA = somatic anxiety;; VS = vertigo severity;; STAI = State Trait Anxiety Inventory;; ACQ = Agoraphobic Cognitions Questionnaire;; BSQ = Body Sensations Questionnaire;; PSSI = Personality Disorder and Type Inventory;; FKV = Freiburg Coping Illness Questionnaire;; MSP = mean slow phases;; OE = organs of equilibrium.

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