Negative prognostic factors for psychological conditions in patients with audiovestibular diseases

Relationship between stress levels and endolymphatic space volume in Meniere's disease

OBJECTIVES

Since the first report by Hallpike and Yamakawa in 1938, many more patients with Meniere's disease (MD) with endolymphatic hydrops (EHs) have been described. Mental/physical stress and a subsequent increase in the release of the anti-diuretic hormone (ADH) supposedly triggers MD. In the present study, to assess the relationship between stress and EHs, we conducted a series of stress-related questionnaires as well as a 3D endolymphatic space (ELS) analysis in patients with unilateral MD.

METHODS

We enrolled 76 patients with unilateral MD (uMD) as the active group and 75 patients with unilateral benign paroxysmal positional vertigo (uBPPV) as the control group; both underwent examinations between June 2014 and November 2019. All patients underwent 3-T magnetic resonance imaging (MRI) 4 h after intravenous gadolinium injection. We used the total fluid space (TFS), ELS, and ELS rate (ELS/TFS × 100), which is the percentage of the volume of the ELS relative to that of the TFS, for a precise evaluation of the ELS and EHs in MD. Stress was evaluated using the Self-Rating Depression Scale (SDS), the psychological Stress Response Scale (SRS), and the modified Dizziness Handicap Inventory (mDHI). Stress scores and blood ADH levels were compared across patient groups.

RESULTS

In patients with uMD, ELS rates significantly correlated with SRS scores on both the affected and the healthy side and with mDHI scores on the affected side, while the SDS and ADH showed no significant correlation with the ELS rates. Correlations were much stronger in the group with severe SDS and one with low ADH levels.

CONCLUSIONS

The present results indicate that stress may be involved in EHs development in uMD, not only in the ipsilateral but also the contralateral ear. They also suggest that patients with neuropsychiatric tendencies may develop EHs and MD in response to a stressful lifestyle.

Modulation of Asymmetry in Auditory Perception through a Bilateral Auditory Intervention

The objective of this work was to analyze the modulating effect of an auditory intervention (AI) on the threshold and symmetry of auditory perception in people with different emotional states. The effects of AI were compared 3 months after using threshold audiometry (air conduction). The studied groups were emotional well-being (EWB) (n = 50, 14 with AI, 36 without AI); anxiety (ANX) (n = 31, 10 with AI, 21 without AI); and mixed group (MIX) (n = 45, 19 with AI, 26 without AI). The EWB group with AI lost the advantage of the left ear due to the hearing gain of the right ear, whereas in EWB without AI, no changes were observed. The ANX group with AI showed a non-significant improvement in both ears, maintaining the left interaural advantage. Interestingly, in the group without AI, the interaural difference was lost. The MIX group did not show interaural differences either with or without AI. However, the AI group showed a lower left ear threshold than that of the right ear, in contrast to the non-AI group. In conclusion, the application of this AI manages to decrease the prioritization of high frequencies, in addition to balance hearing between ears, which could decrease activation in states of anxiety.

Superior Semicircular Canal Dehiscence: A Case Report and Literature Review of an Otologic Condition Associated With Severe Psychiatric Disturbance and Suicide Attempt

We report the case of a man suffering from superior semicircular canal dehiscence with severe audiovestibular symptoms. The patient had a history of posttraumatic stress disorder and traumatic brain injury, and he had a presumed diagnosis of schizophrenia, with suicidal ideation. The patient was treated surgically with complete resolution of his symptoms and a retraction of his schizophrenia diagnosis. This case highlights the overlap between tinnitus and auditory hallucinations, as both result in auditory perception without an external stimulus. Ascertaining the appropriate cause of a patient's auditory symptoms is integral to providing appropriate medical and possibly surgical care.

What Predicts Improvement of Dizziness after Multimodal and Interdisciplinary Day Care Treatment?

Background: Vertigo and dizziness are common in community-dwelling people and can be treated in specialized multidisciplinary settings. To develop tailored interventions, however, we have to explore risk factors for favorable and unfavorable outcomes. Methods: We prospectively investigated patients with chronic vertigo and dizziness subjected to our 5-day multimodal and interdisciplinary day care treatment in the Center for Vertigo and Dizziness of Jena University Hospital, Germany. The Vertigo Severity Scale (VSS), the Body Sensations Questionnaire (BSQ), the Hospital Anxiety and Depression Scale (HADS), the Agoraphobic Cognitions Questionnaire (ACQ), the Mobility Inventory (MI), and the burden and intensity of dizziness (using a visual analogue scale) were assessed at baseline (n = 754) and after 6 months (n = 444). In addition, 14 Likert-scaled questions were used to quantify the change in personal attitude and behavior towards the complaints after 6 months. Results: Dizziness-related burden and intensity improved with a large effect size. The largest improvement was seen in the attitudes towards dizziness, the understanding of somatic causes, and the perceived ability to influence dizziness. However, the ability to work and to carry out professional activity was improved to a lesser extent. The overall improvement of dizziness was associated with the absence of a depressive mood, a short duration of vertigo, a lower VSS, a lower perceived intensity of vertigo, and distinct vertigo diagnoses, namely Meniere’s disease, vestibular migraine, vestibular neuritis, vestibular paroxysmia, and vestibular schwannoma. Worsening of dizziness/vertigo was associated with depressive symptoms, permanent vertigo, distinct vertigo diagnoses (central vertigo, multisensory deficit), and a higher perceived burden due to vertigo. Conclusion: The six-month outcome of patients with dizziness presented to a specialized outpatient clinic appears to be favorable. Nevertheless, people with the abovementioned risk factors at baseline have less benefit and probably need adapted and tailored vertigo interventions to improve long-term outcome.

Modulation of Auditory Perception Laterality under Anxiety and Depression Conditions

The objective of this work is to confirm the asymmetry in non-linguistic auditory perception, as well as the influence of anxiety-depressive disorders on it. Eighty-six people were recruited in the emotional well-being group, fifty-six in the anxiety group, fourteen in the depression group, and seventy-seven in the mixed group. In each group, audiograms were obtained from both ears and the differences were statistically analyzed. Differences in hearing sensitivity were found between both ears in the general population, such differences increased in people with anxiety-depressive disorders. When faced with anxiety-depressive disorders, the right ear suffered greater hearing loss than the left, showing peaks of hyper-hearing at the frequency of 4000 Hz in the anxiety subgroup, and hearing loss in the depression subgroup. In relation to anxiety, the appearance of the 4:8 pattern was observed in the right ear when the person had suffered acute stress in the 2 days prior to the audiometry, and in both ears if they had suffered stress in the 3–30 days before said stress. In conclusion, the advantage of the left ear in auditory perception was increased with these disorders, showing a hyperaudition peak in anxiety and a hearing loss in depression.

Influence of Visual and Vestibular Hypersensitivity on Derealization and Depersonalization in Chronic Dizziness

Objective: The aim of this study was to investigate the relation between visual and vestibular hypersensitivity, and Depersonalization/Derealization symptoms in patients with chronic dizziness. Materials and Methods: 319 adult patients with chronic dizziness for more than 3 months (214 females and 105 males, mean age: 58 years, range: 13-90) were included in this prospective cross-sectional study. Patients underwent a complete audio-vestibular workup and 3 auto questionnaires: Hospital Anxiety and Depression (HAD), Depersonalization/Derealization Inventory (DDI), and an in-house questionnaire (Dizziness in Daily Activity, DDA) assessing 9 activities with a score ranging from 0 (no difficulty) to 10 (maximal discomfort) and 11 (avoidance) to detect patients with visual and vestibular hypersensitivity (VVH, a score > 41 corresponding to mean + 1 standard deviation). Results: DDI scores were higher in case of VVH (6.9 ± 6.79, n = 55 vs. 4.2 ± 4.81, n = 256 without VVH, p < 0.001, unpaired t-test), migraine (6.1 ± 6.40, n = 110 vs. 4.0 ± 4.42, n = 208no migraine, p < 0.001, unpaired t-test), and motion sickness (6.8 ± 5.93, n = 41 vs. 4.4 ± 5.11, n = 277 no motion sickness, p < 0.01, unpaired t-test). Women scored DDI higher than men (5.1 ± 5.42, n = 213 vs. 3.9 ± 4.91, n = 105, respectively, p < 0.05, unpaired t-test). DDI scores were also related to depression and anxiety. DDI score was also higher during spells than during the basal state. Conclusion: During chronic dizziness, Depersonalization/Derealization symptoms seem to be related to anxiety and depression. Moreover, they were prominent in women, in those with visual and vestibular hypersensitivity, migraine, and motion sickness.

Risk Prediction Model for Late Life Depression: Development and Validation on Three Large European Datasets

Assessing the risk to develop a specific disease is the first step towards prevention, both at individual and population levels. The development and validation of risk prediction models (RPMs) is the norm within different fields of medicine but still underused in psychiatry, despite the global impact of mental disorders. In particular, there is a lack of RPMs to assess the risk of developing depression, the first worldwide cause of disability and harbinger of functional decline in old age. We present the depression risk assessment tool DRAT-up, the first prospective RPM to identify late-life depression among community-dwelling subjects aged 60-75. The development of DRAT-up was based on appraisal of relevant literature, extraction of robust risk estimates, and integration into model parameters. A unique feature is the ability to estimate risk even in the presence of missing values. To assess the properties of DRAT-up, a validation study was conducted on three European cohorts, namely, the English Longitudinal Study of Ageing, the Invecchiare nel Chianti, and the Irish Longitudinal Study on Ageing, with 20 206, 1359, and 3124 eligible samples, respectively. The model yielded accurate risk estimation in the three datasets from a small number of predictors. The Brier scores were 0.054, 0.133, and 0.041, respectively, while the values of area under the curve (AUC) were 0.761, 0.736, and 0.768, respectively. Sensitivity analyses suggest robustness to missing values: setting any individual feature to unknown caused the Brier scores to increase by 0.004 and the AUCs to decrease by 0.045 in the worst cases. DRAT-up can be readily used for clinical purposes and to aid policy-making in the field of mental health.

Acupuncture Points Stimulation for Meniere's Disease/Syndrome: A Promising Therapeutic Approach

Objective. This study aims to explore evidence for acupuncture points stimulation (APS) in treatment of Meniere's disease (MD). Method. A literature search was conducted in seven databases including EMBASE, Medline, Cochrane Library, Web of Science, CBM, CNKI, and WangFang database and the data analysis was performed by using the RevMan version 5.3. Results. 12 RCTs with 993 participants were acquired after the search. The quality of most eligible studies was very low which limited the value of the meta-analysis. Compared with western medicine comprehensive treatment (WMCT), the APS alone or in combination with WMCT had a significant positive effect in controlling vertigo; however, the result was negative in hearing improvement and DHI. No adverse events were reported in the studies. Conclusion. The APS might be a promising therapeutic approach for MD. However, the currently available evidence is insufficient to make a definitive conclusion for the poor quality of included studies. More high-quality researches with larger sample size are urgently needed to assess the effectiveness and safety.