Key Features of Chronic Dizziness Improve Diagnosis and Therapeutic Outcomes

http://www.medscape.com/viewarticle/552715
News Author: Laurie Barclay, MD
Release Date: February 26, 2007;

February 26, 2007 — Key clinical features of chronic dizziness may improve diagnosis and therapeutic outcomes, according to the results of a prospective cohort study reported in the February issue of the Archives of Otolaryngology, Head & Neck Surgery.

"The relationships among [chronic subjective dizziness (CSD)], anxiety disorders, neurotologic conditions, and other medical causes of chronic dizziness are not fully understood," write Jeffrey P. Staab, MD, MS, and Michael J. Ruckenstein, MD, of the University of Pennsylvania Health System in Philadelphia, and colleagues. "The current investigation sought to clarify the prevalence and comorbidity of medical and psychiatric causes of chronic dizziness."

From 1998 to 2004 at a tertiary care balance center, 345 men and women, aged 15 to 89 years, were referred for evaluation of chronic dizziness (duration of ≥ 3 months) of uncertain cause. These patients were systematically directed through multiple specialty examinations until definitive diagnoses were reached.

Nearly all patients with CSD were diagnosed with psychiatric or neurologic illnesses, including primary and secondary anxiety disorders (n = 206; 59.7%) and central nervous system conditions (n = 133; 38.6%). The latter group included migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. Six patients (1.7%) had dysrhythmias, and 4 of 5 patients with migraine or dysrhythmias had comorbid anxiety.

"Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments," the authors write. "Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity."

Of the 6 patients with dysrhythmias, all had psychiatric disorders. The most significant dysrhythmias were atrial fibrillation and Wolfe-Parkinson-White syndrome.

"This study demonstrated the clinical usefulness of CSD as a diagnostic concept to identify patients with persistent dizziness sustained by nonotologic mechanisms," the authors conclude. "High levels of coexisting anxiety frequently dominated the clinical picture and confounded recognition of associated medical illnesses. Key diagnostic features were identified in the clinical history for each illness. Careful inquiry about these key features during otologic evaluations may increase diagnostic precision and lead to more specific treatment recommendations for these perplexing patients."

This study was not supported by commercial funding, and the authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2007;133:170-176.