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Vestibular Disorders and Rehabilitation
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The concepts of phobic positional vertigo, space motion discomfort, and chronic subjective dizziness were brought together to produce the entity known as persistent perceptual postural dizziness (PPPD), referring to dizziness, unsteadiness, or non-spinning vertigo that are present pervasively over 3 months or more and that are exacerbated by upright posture, active or passive movement, and exposure to moving or complex visual stimuli and thought to be a functional disorder. Models for explaining PPPD have been drawn from anatomical, neurochemical, and cognitive behavioural theories, and it is considered to be a functional neurological disorder.3 Anxiety and major depressive disorders are common in patients with PPPD but do not occur in all cases.
Neuropsychiatric Aspects of Vestibular Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julius Bourke, Georgia Jackson, Gerald Libby
In the early 2000s, Staab and Ruckenstein19–21 noted that what was previously described as psychogenic dizziness lacked diagnostic specificity as it was also present in migraine, mild traumatic brain injury and dysautonomias. Staab et al. further refined these concepts, removing emphasis from the presence of psychiatric phenomena and presenting the new diagnostic formulation of chronic subjective dizziness (CSD). Staab et al. concede that anxiety is responsible for most of the morbidity of somatoform dizziness but explain that it was not included as a core symptom in order to avoid the assumption that the syndrome is psychiatric alone.5
Vestibular rehabilitation in patients with persistent postural-perceptual dizziness: a scoping review
Published in Hearing, Balance and Communication, 2021
Marco Tramontano, Alessandro Antonio Princi, Sara De Angelis, Iole Indovina, Leonardo Manzari
In 2017, the Committee for Classification of Vestibular Disorders of the Bárány Society [1] unified four dizziness disorders (chronic subjective dizziness [2,3], visually induced dizziness [4], phobic postural vertigo [5], and space and motion discomfort [6]) under the definition of persistent postural perceptual dizziness (PPPD). PPPD is described as persistent non-vertiginous dizziness, unsteadiness, or and swaying or rocking (non-spinning) vertigo [1]. PPPD can be triggered by illnesses that cause vestibular symptoms (for example vestibular neuritis, benign paroxysmal positional vertigo, mild traumatic brain injury, orthostatic hypotension, panic attacks), but persistent dizziness typically emerges after the acute episode resolves, and routine vestibular test results are negative [7]. Persistent symptoms are present most days and are exacerbated by upright posture, active or passive motion, and exposure to moving visual stimuli or complex visual patterns [1]. Symptoms may begin intermittently and then consolidate. Gradual onset is uncommon [8].
Advances in pharmacotherapy of vestibular and ocular motor disorders
Published in Expert Opinion on Pharmacotherapy, 2019
Andreas Zwergal, Michael Strupp, Thomas Brandt
Functional dizziness is a new overall term for vestibular-like disorders of somatoform or psychogenic origin, which integrates disorders, such as persistent postural perceptual dizziness (PPPD), phobic postural vertigo (PPV), or chronic subjective dizziness (CSD) [69]. Previous studies have used variable diagnostic criteria to include patients with heterogenous psychopathologies. Therefore, a separate description of therapeutic effects in defined subtypes of functional dizziness is currently not possible. In principle, selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) are recommended for chronic functional dizziness [70]. However, the existing studies are all open-label non-randomized studies and include different patient populations, so that the evidence level is low. Different agents have been studied for the treatment of functional dizziness. Application of sertraline has shown positive effects on subjective outcome measures like the Dizziness Handicap Inventory in four studies, with response rates between 55% and 67% [71,72]. Effects were better when medication was combined with cognitive behavioral therapy. 18–37% of patients reported adverse effects. Smaller studies have examined the effects of paroxetine, fluoxetine, citalopram, escitalopram, and venlafaxine [73]. A meta-analysis of these studies estimates that up to two-thirds of patients with functional dizziness may respond well to SSRI treatment [72]. However, further validation by randomized trials is needed.
Unilateral vestibular weakness: an often under-recognized entity. Is symptom improvement feasible?
Published in Hearing, Balance and Communication, 2023
Petros V. Vlastarakos, Efterpi Michailidou, Thomas P. Nikolopoulos
Pharmacological treatment in UVW is of limited value, and no study has shown any benefit from using pharmacological agents so far. This comes in stark contrast with the general notion of chronic subjective dizziness, in which balance disorders and fear are correlated and lead to vicious cycle, giving rise to a problem in perception of space and motion, with associated phobias and avoidance behaviour [58]. Treatment in the latter condition includes psychoeducation, behavioural interventions and SSRIs (Figure 3) [58].