Psycho-emotional state of patients with cochleovestibular disorders occurred under stress conditions

Abstract

Topicality: Dizziness is one of the most common symptoms in medical practice. This symptom can be caused by many diseases. One factor which is contributing to dizziness is mental disorders (including depression and anxiety). The problem of psychoemotional stress in recent decades is becoming increasingly important in the world. The COVID-19 pandemic, which was declared by the WHO in 2020, substantially deepened that problem. Numerous studies show that persons of working age suffer most from psychoemotional stress. An urgent task is a selection of scales and questionnaires for persons with dizziness caused by chronic stress. Aim: to increase the effectiveness of diagnosis and treatment of cochleovestibular disorders that caused under stress conditions and develop the rehabilitation events. Materials and methods: 95 patients aged 18 to 59 years were examined with complaints of dizziness caused by stress conditions and 20 people in the control group. 52 patients from main group also complained of tinnitus and 35 of hearing loss. The following studies were carried out for patients: audiometry in full, listening adaptation, detection tests for central auditory disorders, impedance measurement, short-patent auditory induced potentials (CSVP), vestibulometry. The questionnaire was conducted on the following scales: the questionnaire "Comprehensive Stress Assessment" (by Shcherbatykh YuV), the Hospital scale of Anxiety and depression (HADS), the Quality of Life Assessment Scale (by Chaban AS) and the Holmes and Reich social adaptation scale. Non-parametric methods were used for statistical analysis. The difference in comparing of the two independent aggregates was considered valid at p < 0.05. Results: All patients with psychogenic dizziness were divided into three groups depending on the severity of stress. The first group included 21 people (22.1%) with moderate stress, the second group – 35 patients (36.8%) with fairly pronounced stress, and at the third group were 39 people (41.1%) in a state of severe stress (but 10 of them are on the verge of exhaustion of the body's adaptive forces). The average indicators obtained during the questionnaire for the inquirer "Comprehensive stress assessment" in the 1st group were 9.0 (10.5-7) points, in the 2nd group – 17.5 (21-14.5) points and in the 3rd group – 34.0 (28-41.5). The results of the Hospital Anxiety Scale and Depression (HADS) questionnaire are: in 1st group more than half of the subanxiety scale studies was normal; none of the subjects showed clinically pronounced depression and only 3 of them (14.3%) showed subclinically pronounced depression. In group 2nd the anxiety component is more pronounced with a predominance of clinically expressed anxiety; depression was diagnosed only in 37.1% with a predominance of subclinically pronounced depression. In the 3rd group on the anxiety sub-scale, the normal results had only 2 persons (5.1%), moreover, clinical anxiety was prevalent in most patients. In according with subscale of depression, about a third of patients have normal indicators and almost half of the subjects tested have subclinically pronounced depression. According to the Holmes and Reich Social Adaptation Scale, in most cases (57 patients) there was low level of stress, 31 people had an average level of stress and only 7 had a high. The results of the assessment of life quality according to the Chaban A. S. scale: in eight categories, life quality indicators decreased inversely in proportion to the increase in the severity of stress. The best indicators were obtained in the category of satisfaction with living conditions. The worst indicators are in the categories of satisfaction with physical condition and love. Conclusions: 36.8% of the studied ones have quite pronounced stress of emotional and physiological systems, 41.1% - state of severe stress and 10.5% - exhaustion of the body's adaptive forces. Patients with dizziness that was caused by stress should be interviewed using validated scales: the questionnaire "Comprehensive Stress Assessment", the Hospital Anxiety Scale and Depression (HADS) and the Quality of Life Assessment Scale. The use of other scales to determine the psychoemotional state and quality of life of such patients is the subject for further researches. In according with used questionnaires from 7.4 (Holmes and Reich Scale of Social Adaptation) up to 78.9% (Hospital Anxiety and Depression Scale (HADS)) of working-age persons who were under stress, except for otolaryngological treatment, in need of a medical psychologist. These measures will provide an opportunity to increase the speed of the treatment process and improve patient’s quality of life.