Improving the quality of life in patients with vestibular disorders: the role of medical treatments and physical rehabilitation
E. Mira
Department of Otolaryngology and Head Neck Surgery, University of Pavia and IRCCS Policlinico San Matteo, Pavia, Italy
Search for more papers by this authorE. Mira
Department of Otolaryngology and Head Neck Surgery, University of Pavia and IRCCS Policlinico San Matteo, Pavia, Italy
Search for more papers by this authorSummary
Vertigo, dizziness and imbalance are the main symptoms of vestibular disorders. They can lead to physical consequences, such as reduced postural control and falls, to psychologic/psychiatric consequences, such as anxiety-depression symptoms, panic and agoraphobia, and to cognitive defects, especially in the elderly. Consequently, the general health status and the quality of life (QoL) of vestibular patients can be significantly impaired. Several questionnaires have been developed in an attempt to quantify the degree of handicap and disability, the self-perceived health status and the quality of life in vestibular patients with dizziness and imbalance. Additionally, the main goal of the treatments of vestibular disorders should be to control symptoms, reduce functional disability and to improve patients’ QoL. This article reviews the physical and psychological consequences of the vestibular disorders, their impact on the patients’ QoL, and the treatment options, including drug prescriptions and vestibular rehabilitation protocols. A profile of the compound betahistine and its efficacy on QoL indices in the treatment of Menière's disease and other forms of peripheral vertigo is also presented.
References
- 1 Toole JF. Some neurologic syndromes. In: JA Barondess, CC Carpenter, eds. Differential Diagnosis. Philadelphia: Lea & Febiger 1994: 701–24.
- 2 Hanley K, O'Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract 2001; 51: 666–71.
- 3 Kroenke K, Lucas CA, Rosenberg ML et al. Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care. Ann Intern Med 1992; 117: 898–904.
- 4 Hanley K, O'Dowd T. Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract 2002; 52: 809–12.
- 5 Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med 1998; 339: 680–5.
- 6 Beers MH, Berkow R. Merck Manual of Diagnosis and Therapy, 17th edn. Whitehouse Station, NJ: Merck & Co., 1999: 665–7, 678–83.
- 7 Soderman AC, Bagger-Sjoback D, Bergenius J, Langius A. Factors influencing quality of life in patients with Meniere's disease, identified by a multidimensional approach. Otol Neurotol 2002; 23: 941–8.
- 8 Fielder H, Denholm SW, Lyons RA, Fielder CP. Measurements of health status in patients with vertigo. Clin Otolaryngol 1996; 21: 124–6.
- 9 Aggarwal NY, Bennett DA, Bienias JL, Mendes Leon de CF, Morris MC, Evans DA. The prevalence of dizziness and its association with functional disability in a biracial community population. J Gerontol A Biol Sci Med Sci 2000; 55: M288–92.
- 10 Monzani D, Casolari L, Guidetti G, Rigatelli M. Psychological distress and disability in patients with vertigo. Psychosom Res 2001; 50: 319–23.
- 11 Pothula VB, Chew F, Lesser TH, Sharma AK. Falls and vestibular impairment. Clin Otolaryngol Allied Sci 2004; 29: 179–82.
- 12 Gufoni M, Guidetti G, Nuti D et al. The relationship between cognitive impairment, anxiety-depression symptoms and balance and spatial orientation complaints in the elderly. Acta Otorhinolaryngol Ital 2005; 25 (3 Suppl 79): 12–21.
- 13 Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990; 116: 424–7.
- 14 Ware JE, Snow KK, Kosinski M et al. SF-36 Health Survey: Manual and Interpretation Guide. QualityMetrie, Lincoln, RI, 1993.
- 15 Shepard NT, Telain SA. Practical Management of the Balance Disordered Patient. Singular Publishing Group, San Diego, CA, 1996.
- 16 Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol 1995; 50: M28–34.
- 17 Cohen HS, Kimball KT. Development of the vestibular disorders activities of daily living scale. Arch Otolaryngol Head Neck Surg 2000; 126: 881–7.
- 18 Albera R, Ciuffolotti R, Di Cicco M et al. Double-blind, randomized, multicenter study comparing the effect of betahistine and flunarizine on the dizziness handicap in patients with recurrent vestibular vertigo. Acta Otolaryngol 2003; 123: 588–93.
- 19 Tinetti ME. Falls. In: WR Hazzard, R Andres, EL Bierman, eds. Principles of Geriatric Medicine and Gerontology, 2nd edn. New York: McGraw-Hill 1990: 1192–9.
- 20 Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol 2000; 21: 847–51.
- 21 Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal vertigo in elderly patients. Otolaryngol Head Neck Surg 2000; 122: 630–4.
- 22 Balaban CD, Jacob RG. Background and history of the interface between anxiety and vertigo. J Anxiety Disord 2001; 15: 27–51.
- 23 Yardley L, Beech S, Zander L, Evans T, Weinman J. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract 1998a; 48: 1136–40.
- 24 Yardley L, Burgneay J, Nazareth I, Luxon L. Neuro-otological and psychiatric abnormalities in a community sample of people with dizziness: a blind, controlled investigation. J Neurol Neurosurg Psychiatry 1998b; 65: 679–84.
- 25 Yardley L. Overview of psychologic effects of chronic dizziness and balance disorders. Otolaryngol Clin North Am 2000; 33: 603–16.
- 26 Yardley L, Owen N, Nazareth I, Luxon L. Panic disorder with agoraphobia associated with dizziness: characteristic symptoms and psychosocial sequelae. J Nerv Ment Dis 2001; 189: 321–7.
- 27 Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope 2003; 113: 1714–8.
- 28 Jacob RG, Furman JM, Durrant JD, Turner SM. Panic, agoraphobia, and vestibular dysfunction. Am J Psychiatry 1996; 153: 503–12.
- 29 Yardley L, Putman J. Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci 1992; 17: 231–6.
- 30 Eagger S, Luxon LM, Davies RA, Coelho A, Ron MA. Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry 1992; 55: 383–7.
- 31 Pollak L, Klein C, Rafael S et al. Anxiety in the first attack of vertigo. Otolaryngol Head Neck Surg 2003; 128: 829–34.
- 32 Yardley L, Redfern MS. Psychological factors influencing recovery from balance disorders. Anxiety Disord 2001; 15: 107–19.
- 33 Smith PF, Zheng Y, Horii A, Darlington CL. Does vestibular damage cause cognitive dysfunction in humans? J Vestib Res 2005; 15: 1–9.
- 34 Yardley L, Dibb B, Osborne G. Factors associated with quality of life in Meniere's disease. Clin Otolaryngol Allied Sci 2003; 28: 436–41.
- 35 Cohen HS, Wells J, Kimball KT, Owsley C. Driving disability and dizziness. J Safety Res 2003; 34: 361–9.
- 36 Magliulo G, Bertin S, Ruggieri M, Gagliardi M. Benign paroxysmal positional vertigo and post-treatment quality of life. Eur Arch Otorhinolaryngol 2005; 262: 627–30.
- 37 Claes J, Van de Heyning PH. A review of medical treatment for Meniere's disease. Acta Otolaryngol Suppl 2000; 544: 34–9.
- 38 Mira E, Guidetti G, Ghilardi L, Fattori B, Malannino N, Maiolino L et al. Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo. Eur Arch Otorhinolaryngol 2003; 260: 73–7.
- 39 Cohen HS, Kimball KT. Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003; 128: 60–70.
- 40 Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS Drugs 2003; 17: 85–100.
- 41
Hecker HC,
Hau CO,
Herndon JW.
Treatment of vertiginous patient using Cawthorne's vestibular exercises.
Laryngoscope
1974; 11: 2065–72.
10.1002/lary.5540841121 Google Scholar
- 42 Cohen H. Vestibular rehabilitation reduces functional disability. Otolaryngol Head Neck Surg 1992; 107: 638–43.
- 43 Cohen HS. Disability and rehabilitation in the dizzy patient. Curr Opin Neurol 2006; 19: 49–54.
- 44 Cohen H. Vestibular rehabilitation improves daily life function. Am J Occup Ther 1994; 48: 919–25.
- 45 Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM. Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med 2004; 141: 598–605.
- 46 Mira E. Betahistine in the treatment of vertigo. History and clinical implications of recent pharmacological researches. Acta Otorhinolaryngol Ital 2001; 21 (3 Suppl 66): 1–7.
- 47 Lacour M, Sterkers O. Histamine and betahistine in the treatment of vertigo: elucidation of mechanisms of action. CNS Drugs 2001; 15: 853–70.
- 48 Schmidt TJ, Huizing EH. The clinical drug trial in Meniere's disease with emphasis on the effect of betahistine SR. Acta Ootolaryngol (Stockh) 1992; 497: 1–189.
- 49 Elia JC. Double blind evaluation of a new treatment for Meniere's syndrome. JAMA 1966; 196: 187–9.
- 50 Bertrand RA. Long-term evaluation of the treatment of Meniere's disease with betahistine HCl. Adv Otorhinolaryngol 1982; 28: 104–10.
- 51 Oosterveld WJ. Betahistine dihydrochloride in the treatment of vertigo of peripheral vestibular origin. A double-blind placebo-controlled study. J Laryngol Otol 1984; 98: 37–41.
- 52 Fraysse B, Bebear JP, Dubreuil C, Berges C, Dauman R. Betahistine dihydrochloride versus flunarizine. A double-blind study on recurrent vertigo with or without cochlear syndrome typical of Meniere's disease. Acta Otolaryngol Suppl 1991; 490: 1–10.
- 53 Frew IJ, Menon GN. Betahistine hydrochloride in Meniere's disease. Postgrad Med J 1976; 52: 501–3.
- 54 Wilmot TJ, Menon GN. Betahistine in Meniere's disease. J Laryngol Otol 1976; 90: 833–40.
- 55 Colletti V. Medical treatment in Meniere's disease: avoiding vestibular neurectomy and facilitating postoperative compensation. Acta Otolaryngol Suppl 2000; 544: 27–33.
- 56 Elbaz P. Flunarizine and betahistine. Two different therapeutic approaches in vertigo compared in a double-blind study. Acta Otolaryngol Suppl 1988; 460: 143–8.