Impact Of Dizziness Research Articles

Comparing in-clinic versus telehealth for vestibular physical therapy.

Vestibular rehabilitation (VR) is a commonly employed treatment method for disorders of dizziness and imbalance. Access to a clinic for rehabilitation appointments can be challenging for a person experiencing dizziness. Telehealth may offer a comparable alternative to clinic-based VR for some patients. The objective of this study was to determine the efficacy of telehealth-based VR compared to traditional clinic-based VR, as measured with the Dizziness Handicapped Inventory (DHI) in a retrospective sample of patients with vestibular conditions. This is a retrospective, multi-institutional review from May 2020 to January 2021. Three study groups were analyzed: a telehealth group, a hybrid group, and a clinic based control group. Treatment efficacy was measured using the DHI. A repeated measures ANCOVA was performed to compare changes between the groups and across timepoints. The repeated measures ANCOVA was not significant for the interaction of groups (control, telehealth, and hybrid) by time (pre and post) (p > 0.05). However, there was a significant main effect for time (pre and post) (p < 0.05). Specifically, all groups improved DHI scores from pre to post treatment with mean differences of control: 31.85 points, telehealth: 18.75 points, and hybrid: 21.45 points. Findings showed that in-clinic, telehealth, and hybrid groups demonstrated a decrease in DHI scores, indicating self-reported improvements in the impact of dizziness on daily life. Continued research is recommended to explore the efficacy of using telehealth in assessing and treating vestibular conditions.

Psychological factors and long-term tinnitus handicap in vestibular schwannoma patients after retrosigmoid microsurgery – a cross-sectional study

Objective This study aimed to investigate the connection between psychological factors and postoperative tinnitus in vestibular schwannoma (VS) patients following retrosigmoid microsurgery. Design Cross-sectional study. Study sample Ninety-three VS patients participated, completing questionnaires on demographics, tinnitus severity (THI-12), personality traits (TIPI-G), dizziness impact (DHI), perceived health benefits (GBI), somatisation tendencies (SOMS-2), and psychological distress (HADS-D). Our analysis involved Mann-Whitney U-tests, Spearman’s rank-order correlations, and false discovery rate correction. Results Most participants reported postoperative tinnitus (77/93), with 41 experiencing it preoperatively. Emotional stability correlated negatively with tinnitus presence, while tinnitus severity was associated with emotional distress. Preoperative somatisation tendencies were also positively linked to tinnitus severity. Postoperative Tinnitus was further linked to reduced perceived health benefits and increased anxiety and depression levels. Notably, age and gender showed no significant associations. Conclusion This study uncovers the interplay between postoperative tinnitus and psychological factors in VS patients, highlighting emotional and cognitive dimensions. Tailored psychological interventions addressing tinnitus‘s psychosomatic impact may enhance patients quality of life.

Clinical Manifestations.

the vestibular system has neural connections from the vestibular nucleus to limbic and cortical areas, involved in both cognition and spatial orientation. The superior vestibular cortex consists of a network that interacts with other sensory systems, such as visual, sensorimotor, motor and cognition. Studies have found structural changes in the brain of patients with persistent perceptual postural dizziness (PPPD) when compared to controls, particularly in visual, vestibular and limbic areas, including a decrease in gray matter volume and turnover, a decrease in blood flow to the cortex region. cross-sectional, observational and analytical study. The sample consisted of 50 elderly people, of both sexes, aged between 60 and 86 years. Elderly individuals with vestibular dysfunction confirmed by Vestibular Evoked Myogenic Potential (VEMP) and Video Head Impulse Test (v-HIT) tests were included. Balance and the impact of dizziness on quality of life were evaluated through tests and vestibular scales. Cognition, functioning and depression were assessed in a quiet room using tests and scales. Univariate analysis was performed using the Spearman test. Variables that presented correlation ≤ 0.2 were selected for multivariate analysis by linear regression. A significance level of 5% was adopted (p< 0.05). there was a correlation between vestibular dysfunction and imbalance with the results of neuropsychological assessment (p = 0.000), depressive symptoms (p = 0.001) and functionality (p = 0.002). in this present study, a correlation was found between vestibular dysfunction and imbalance with the worst clinical and functional indices, worse functionality, depressive symptoms and in visuospatial function skills, executive functions and praxis.

Ten-year incidence, predictors and impact of dizziness and vertigo in community-dwelling adults

ObjectivesWe used a cohort of community-dwelling adults to establish the 10-year incidence and predictors of dizziness/vertigo, and its impacts on health-related quality of life. Study designOf the 1152 participants aged 55 + years who did not have dizziness/vertigo at baseline, 799 and 377 participants were followed up after 5 and 10 years, respectively, and had complete data and so were included in the incidence analysis. Hearing loss was determined as the pure-tone average of audiometric hearing thresholds at 500, 1000, 2000 and 4000 Hz, and any hearing loss was defined as >25 dB hearing level. Tinnitus and migraine were assessed by a positive response to a single question. Main outcome measuresAudiologists screened participants for reported dizziness using a single question. Quality of life was measured using the Short Form 36-item Health Survey (SF-36). ResultsThe cumulative 10-year incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo were 39.8 %, 27.1 %, and 11.9 %, respectively. Age and presence of migraine were significant predictors of incident dizziness/vertigo: multivariable-adjusted hazard ratio (HR) 1.03 (95 % confidence interval, CI, 1.01–1.06) and HR 1.63 (95 % CI 1.13–2.35), respectively. A significant decrease in scores for the following SF-36 domains was observed over the 10 years among participants reporting baseline dizziness/vertigo: physical functioning (P-trend ≤ 0.0001), role limitation due to physical problems (P-trend ≤ 0.0001), general health (P-trend = 0.01), and vitality (P-trend = 0.01). ConclusionsDizziness/vertigo was a frequent and detrimental symptom in this population of community-dwelling adults. Our study highlights the burden imposed by dizziness, as evidenced by a significant prospective association with poorer quality of life.

Balance Disorder Trends in US Adults 2008-2016: Epidemiology and Functional Impact.

To quantify the changes in prevalence and impact of dizziness and balance disorders in adults from 2008 to 2016. Epidemiological survey analysis. United States. The balance modules of the adult 2008 and 2016 National Health Interview Surveys were examined, and persons reporting dizziness or balance problems identified. The prevalence of balance problems was determined and compared over time, adjusting for age and sex. Among those with balance problems, associated symptoms and self-reported functional limitations were quantified and compared over time. In 2016, 36.8 ± 1.0 million (15.5% ± 0.3%) adults reported a balance problem in the past year, versus 24.2 ± 0.7 million (11.% ± 0.3%) in 2008 (p < .001). After adjustment for age and sex, this percentage increase remained significant (odds ratio 1.435 [1.332-1.546], p < .001). Among those with balance problems, significantly more patients reported specific issues with feeling: off-balance (69.4% vs. 65.4%; p = .005), faint (48.5% vs. 40.3%; p < .001), or vertiginous (45.9% vs. 39.3%; p < .001) in 2016 than 2008. More adults experienced anxiety (29.4% vs. 19.4%; p < .001) and depression (16.3% vs. 12.9%; p = .002) with their balance problems in 2016 than in 2008. In 2016, adults with balance problems were limited in ability to drive motor vehicles (13.0%), exercise (14.4%), or walk downstairs (12.8%). These rates were not significantly different from 2008 (all p > .05). In this nationally representative analysis, we found a significantly increasing prevalence of balance problems and associated psychiatric symptom burden. This merits attention with respect to present and future health care resource allocation.

Efetividade da reabilitação vestibular no equilíbrio, tontura, funcionalidade e sintomas depressivos em idosos

ABSTRACT Purpose To assess the effectiveness of vestibular rehabilitation on functioning, gains in semicircular canals in the Video Head Impulse Test (v-HIT), on responses to the vestibular evoked myogenic potentials (VEMP), depressive symptoms, balance, and dizziness in older adults. Methods Longitudinal, quasi-experimental, analytical study conducted between December 2019 and July 2022, in 50 older adults with vestibular disorders, submitted to vestibular rehabilitation and examinations: VEMP, v-HIT, the questionnaires, visual analog scale, Dizziness Handicap Inventory, Berg Balance Scale, Pfeffer’s Functional Activities Questionnaire, and Geriatric Depression Scale. All examinations and questionnaires were applied before and after eight weekly vestibular rehabilitation sessions. Statistical analysis was performed in SPSS, with the Wilcoxon test (p&lt;0.05). Results There was a gain in the anterior right semicircular canal (0.71/0.78), reduction in dizziness discomfort (7/5) and in the impact of dizziness on the quality of life (35/15), improvement in balance (45/51) and functioning (2/1), and reduction in depressive symptoms (5/3). Conclusion Older adults with vestibular disorder submitted to vestibular rehabilitation improved their gain in vestibulo-ocular reflex, balance, and functional activities and reduced their depressive symptoms and the impact of dizziness on their quality of life.

Factors affecting the outcome of vestibular rehabilitation in patients with peripheral vestibular disorders

ObjectivePrevious studies have reported that developmental, environmental, medical, psychological, visual, and other sensory-related factors can influence the outcome of vestibular rehabilitation. However, only a few studies have used patient's daily lives as the main outcome. In addition, in some studies, rehabilitation was not supervised by a physical therapist. This study aimed to determine the factors associated with the outcome of physical-therapist-supervised vestibular rehabilitation in patients with peripheral vestibular disorders, with the impact of dizziness on quality of life as the main outcome. MethodsThis retrospective cohort study included 47 patients with peripheral vestibular disorders. A physical therapist provided 40 min of vestibular rehabilitation once a week for 4 weeks. Age, sex, disease duration, Dizziness Handicap Inventory (DHI), Timed Up-and-Go test (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Activity-Specific Balance Confidence Scale (ABC scale), and Hospital Anxiety and Depression Scale (HADS) were investigated. Multiple regression analysis was performed, with the DHI rate of change before and after the intervention as the objective variable. ResultsVestibular rehabilitation improved all outcomes. In the multiple regression analysis, the ABC scale was identified as a factor that significantly influenced the DHI rate of change (β = -0.428, p < 0.01). ConclusionA higher ABC scale score was associated with a lower DHI rate of change (i.e., better improvement). Therefore, it may be important to assess psychological aspects, especially confidence in balance, when implementing vestibular rehabilitation in patients with peripheral vestibular disorders.

Impact of Common Dizziness Associated Symptoms on Dizziness Handicap in Older Adults.

Background: A cross-sectional observational study was designed to determine the impact of dizziness associated symptoms on the dizziness handicap inventory (DHI) in older adults (≥60 years).Methods: In total, 785 individuals referred to a multidisciplinary dizziness unit were assessed. Participants completed self-report questionnaires with general questions about symptoms of dizziness as well as the DHI. The DHI subscores (physical, functional, emotional) were calculated. Medical diagnoses were collected from the medical records of the patients. One-way MANOVA and networking analysis were used to analyze the impact of dizziness associated symptoms on dizziness handicap.Results: Most patients reported swaying dizziness (60.6%) and feeling of unsteadiness (59.8%) with substantial overlap between the types of dizziness. Most frequent dizziness associated symptoms were ear noise/tinnitus, visual problems, and nausea/vomiting. Network analysis revealed that visual disturbances, headache, and hearing impairment were associated with higher DHI and explained 12% of the DHI variance in the linear regression. In the one-way MANOVA visual problems and headache had an effect on all three DHI subscores, while hearing impairment was associated with the functional and emotional subscores of DHI.Conclusion: Distinct dizziness associated symptoms have substantial impact on dizziness handicap in older adults. A multifactorial assessment including these symptoms may assist in tailoring therapies to alleviate dizziness handicap in this group.

Clinical practicality of the dizziness handicap inventory for evaluating dizziness in the Mandarin Chinese-speaking population: a prospective cross-sectional analysis

Objective To explore the clinical practicality of the dizziness handicap inventory (DHI) in the Mandarin Chinese-speaking population and compare patients’ and physicians’ assessments of the impact of dizziness on the quality of life using the DHI. Design Prospective cross-sectional. Study sample Overall, 144 consecutive patients aged ≥ 18 years seeking treatment for dizziness in an Ear-Nose-Throat clinic in China. Results Some items in the DHI could not be completed by both patients (46/144, 31.9%) and physicians (26/144, 18.1%). In fully completed DHIs (98/144, 68.1%), the patients’ self-assessment scores were higher than the physicians’ assessment scores (average 44.04 ± 21.38 vs 35.94 ± 16.99; p < 0.05). The strength of the correlation between the patients’ and physicians’ total DHI scores was high (r = 0.80; p < 0.05). Moreover, at a cut-off point of 18, the discrepancy scores of 77.6% (76/98) of the cases did not exceed the minimum detectable change (MDC) of the DHI. Conclusions The clinical practicality of the DHI in such settings requires improvement. Even though physician interviews can increase the degree of questionnaire completion, not all items can be completed. Although the physicians’ assessment scores were lower than the patients’ self-assessment scores, the majority of the discordancy scores were within the MDC of the DHI.

Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study.

The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

Comparison of two protocols aimed to evaluate the impact of dizziness in patients with vestibular disorders

Exploring emotional aspects commonly associated with the symptom of dizziness is essential for a better understanding and prognosis of vestibular disorder, once it is known that dizziness can be associate as a cause or consequence from psychological disorders. The aim of this study was to analyse the emotional impact caused by dizziness/vertigo symptom in vestibulopathic patients comparing two protocols: Dizziness Handicap Inventory (DHI) and Questionário de Impacto Emocional da Vertigem (CIEV). We concluded that both questionnaires can be used to evalute the impact of dizziness in patients' quality of life, but they explore different aspects being considered complementary during the diagnosis and for a better prognosis.

The Impact of Dizziness on Daily Activities in Patients with Temporomandibular Dysfunction

The Impact of Dizziness on Daily Activities in Patients with Temporomandibular Dysfunction

Impacts of small vestibular schwannoma on community ambulation, postural, and ocular control

To investigate balance, community mobility, gaze instability, and dizziness handicap and assess falls risk in people who are conservatively managed with small vestibular schwannoma (VS). Cross-sectional study with controls. The study involved 18 people (mean age 58.7 ± 12.2 years) diagnosed with VS (<12 mm) and 22 age-matched controls (mean age 56.9 ± 8.0 years). Measures included standing on firm and foam surfaces with feet apart, then together with eyes open and closed, Timed Up and Go (TUG) test and dual TUG test, Dynamic Gait Index, 6-Minute Walk Test, Halmagyi Impulse Test, Dynamic Visual Acuity Test, and the Dizziness Handicap Inventory. The clinical group failed more trials standing feet together on foam with eyes closed (P < .05); had inferior mobility and walked more slowly with divided attention (P < .05); had more difficulty walking with head movement, negotiating obstacles, and using stairs (P < .01); and walked shorter distances (P < .001) than controls. Reduced gaze stability (P < .01) and higher total (P = .007) and subcategory dizziness handicap scores (P < .05) were revealed compared to age-matched controls. Although outcomes for the clinical group are inferior to the control group across all measures and the dizziness impact is higher, the results fall in the low-risk category for falls. Preliminary data (level 4 evidence) support using a suite of clinical measures to monitor people with VS during conservative management. 4 Laryngoscope, 127:1147-1152, 2017.

The impact of dizziness on quality-of-life in the elderly.

Dizziness is a common medical condition that has been related to falls in the elderly, and it is, therefore, considered a severe social health problem. Particularly in the elderly, the impact of dizziness may be relevant, as it has been linked to several conditions, such as isolation, depression, reduced self autonomy, and self control. The social, functional, and psychological well-being of those affected can be hampered significantly, thus reducing the quality-of-life (QoL) perception. In addition, due to the aging of the population in the developed world, dizziness is becoming a growing public health problem; an optimal management of this condition includes, nowadays, the improvement of rehabilitative programs, as well as the evaluation of QoL status and its management. The aim of this paper is to evaluate the impact of dizziness on the QoL in the elderly, also analyzing the instruments available, nowadays, to evaluate QoL of dizzy patients.

EHMTI-0194. The impact of dizziness in tertiary care migraine patients

The association between dizziness and migraine has been proven. There is no data available on the relationship between dizziness and impact or disability scores in tertiary clinic migraine patients.

Impact of dizziness and obesity on the prevalence of falls and fall-related injuries.

Quantify the relationships between dizziness, falls, and obesity among adults. Cross-sectional analysis of a national health survey. Adult respondents in the 2008 National Health Interview Survey balance module were analyzed. With demographic information, data for balance and dizziness problems, reported falls, injuries from falls, and body mass index were extracted. Associations between balance/dizziness problems and falls or injuries from falls were determined. The additional association between obesity and falls or fall-related injuries in the setting of a balance/dizziness problem was determined. Among 216.8 ± 3.5 million adult Americans, 24.2 ± 0.7 million reported dizziness in the past 12 months (11.1% ± 0.3%; mean age, 45.9 ± 0.2 years; 51.7% ± 0.5% female), 11.5% ± 0.3% had fallen in the prior 12 months, and 26.3% ± 0.4% were obese. Among individuals reporting dizziness, 34.3% ± 1.3% reported falls, whereas only 9.1% ± 0.3% of nondizzy individuals reported a fall (odds ratio [OR]: 5.1; P < .001). Among dizzy individuals who reported a fall, 45.8% ± 2.1% were injured by the fall versus 35.6% ± 1.4% nondizzy individuals who fell (OR: 1.5; P < .001). The addition of obesity to dizziness increased the odds of falling by 1.3 (95% confidence interval: 1.2-1.5; P < .001) but did not significantly increase the odds of fall-related injury (P = .110). Dizziness/balance problems are strongly associated with both an increased tendency to fall and increased injury rate from falls among adults. The addition of obesity to dizziness was associated with a higher rate of falling but was not associated with a significantly higher rate of fall-related injury. Balance problems in conjunction with obesity need to be targeted in fall-prevention efforts. 2b.

Body Balance Rehabilitation in Older Persons with Peripheral Chronic Vestibular Disease

Objectives: Evaluate the efficacy of a balance rehabilitation program in older persons with chronic vestibular disease. Methods: Prospective clinical trial conducted from September 2011 to December 2012. Setting: University center for balance disorders. Eligible patients (over 60 years old) with chronic vestibular disease underwent 12 to 16 sessions of individual body balance rehabilitation program (BRP). Each session lasted 60 minutes, twice per week, and was associated with diet orientation and daily exercises for labyrinth stimulation. Before and after therapy, the following data were collected: patient complaints, the Functional Gait Assessment, the Brazilian OARS Multidimensional Functional Assessment Questionnaire, the Dizziness Handicap Inventory (DHI) and static posturography parameters (limit of stability and balance functional reserve in ten visual, vestibular, and somatosensory conflicts). Results: Of 20 patients, 90.9% were female, with mean age of 71.70 years old. After BRP, there was reduction of most of symptoms (dizziness, imbalance and nausea), improvement in functional capacity ( P &lt; 0.05), gait stability ( P = 0.003) and reduction in DHI scores ( P = 0.001). The limit of stability measure increased ( P = 0.001) and also the body balance functional reserve, mainly in conditions 2, 3 and 4 ( P = 0.001) and 5 ( P = 0.020). Conclusions: A body balance rehabilitation program was effective in reduction of symptoms, fall risk, and dizziness impact on quality of life in elderly patients with vestibular disorders, improving functional capacity, gait stability, and increasing the limit of stability and the balance functional reserve.

Substantial burden of dizziness in multiple sclerosis

ObjectiveDizziness affects 49–59% of persons with MS but few prior studies examined the impact of dizziness in persons with multiple sclerosis (MS). Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we examined the measurement properties of the Dizziness Handicap Inventory (DHI) in persons with MS, and the association between the DHI and health-related quality of life (HRQOL). Materials and methodsIn 2004, NARCOMS participants completed the DHI. We scored the DHI for each participant and evaluated the association of the DHI scores and the participant demographic and clinical characteristics of interest using t-tests and Kruskal–Wallis tests as appropriate. We examined the association between the DHI scores and HRQOL (PCS-12, MCS-12) and disability status using Spearman rank correlations and generalized linear models. Results8123 participants completed the questionnaire, of whom 74.5% were women and 96.6% were white. Their mean (SD) age of symptom onset was 30.3 (9.7) years and median (IQR) score on Patient Determined Disease Steps (PDDS) was 4 (1–6). The median (interquartile range) DHI score was 20 (0–44). The impact of dizziness could be classified as mild in over 60% of participants (n=4660), moderate in 30.9% (n=2340) and severe in 7.55% (n=572). The odds of reporting moderate or severe dizziness were reduced with higher socioeconomic status (post-graduate degree vs. less than high school education odds ratio [OR] 0.38; 95% confidence interval [CI]: 0.28–0.52) and increased with higher levels of disability (severe vs. mild disability OR 1.38; 95% CI: 1.13–1.68). Physical and mental HRQOL decreased as the impact of dizziness increased (DHI-PCS-12 r=−0.34, DHI-MCS-12 r=−0.37). ConclusionsDizziness is common in MS and adversely impacts quality of life. More effective management of this symptom may improve HRQOL and deserves more attention.

High Frequency and Adverse Impact of Vertigo and Dizziness in Multiple Sclerosis (P07.075)

Objective: Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry data, we examined factors that worsened the level and impact of dizziness or vertigo (DOV) in persons with MS. Background Few prior studies examined the frequency or impact of DOV in MS. Design/Methods: In 2004, registry participants answered questions regarding DOV, including what factors aggravated their symptoms, and how their symptoms influenced their daily activities. Results: 8123 participants completed the questionnaire, of whom 74.5% were women, 96.6% white, and 70.2% married/ co-habiting. Their mean (SD) age of symptom onset was 30.3 (9.7) years and median (IQR) score on Patient Determined Disease Steps (PDDS) was 4 (1-6). Nearly all participants reported at least some difficulty with DOV (N = 8122). DOV frequently worsened with head movement (56.0%), bending over (54.5%) and looking upward (47.5%), but infrequently with turning over in bed (19.4%). As compared to men, women more often reported that looking up (p=0.003), head movement (p Conclusions: Dizziness or vertigo are frequent, limit daily activities, and adversely affect relationships in MS. More effective management is needed. Supported by: NARCOMS is a CMSC project. Disclosure: Dr. Marrie has nothing to disclose. Dr. Cutter has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals, Inc., Cleveland Clinic, Daiichi Pharmaceutical Corporation, GlaxoSmithKline, Inc., Genmab Biopharmaceuticals, Eli Lilly & Company, Medivation, Modigenetech, Ono Pharmaceutical, PTC Therapeutics, Teva Neuroscience, Vivus, University of Pennsylvania, NHLBI, NINDS, NMSS, Alexion, Bayhill Therapeutics, Bayer Pharmaceuticals Corporation, Celgene, Novartis, Consortium of MS Centers, Genzyme Corporation, Klein-Buendel Incorporated, Nuron Biotech, Peptimmune, Somnus Pharmaceuticals, Sandoz, University of Texas Southwestern and Visioneering Technologies, Inc. Dr. Cutter has received compensation for serving on the board of Pythagoras, INC. Dr. Cutter has received research support from various pharmaceutical corporations. Dr. Tyry has nothing to disclose.

Imipramine for vestibular dysfunction in panic disorder: a prospective case series

The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI). At the baseline 33.3% (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day). This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.