Wei Wei, Sayyid Zahra N, Ma Xiulan, Wang Tian, Dong Yaodong
Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.
Front Neurol. 2018 Mar 21;9:178. doi: 10.3389/fneur.2018.00178. eCollection 2018.
To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV).
This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student's -test, χ test, and logistic regression analysis were used as appropriate. A value less than 0.05 was considered statistically significant.
The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; = 0.001) and female gender (Relative-risk ratio: 4.563; = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver.
Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
探讨焦虑和/或抑郁症状对良性阵发性位置性眩晕（BPPV）治疗效果及复发的可能影响。
本研究为在单一机构开展的回顾性研究。对2016年10月至2017年7月在中国医科大学附属盛京医院耳鼻咽喉科连续诊断为特发性BPPV的142例患者进行回顾性分析。最终127例患者纳入本研究。采用zung自评焦虑量表（SAS）和zung自评抑郁量表（SDS）分别评估BPPV患者焦虑和/或抑郁症状的存在情况。显著评分（SAS≥50分，SDS≥53分）表示存在具有临床意义的症状。根据情况适当采用双尾t检验、χ检验和逻辑回归分析。P值小于0.05被认为具有统计学意义。
本研究中BPPV患者焦虑和/或抑郁症状的患病率为49.61%。首次行耳石复位手法（CRM）的有效率为70.08%。通过每周进行CRM随访治疗，1个月时成功率提高到97.64%。治愈后6个月随访的总复发率为14.17%。在所有其他变量保持不变的情况下，有精神症状的患者（相对危险比：3.160；P = 0.027）和非后半规管（PSC）受累的患者（相对危险比：7.828，P = 0.013）即使在有效的CRM治疗后仍更有可能出现残余头晕（RD）。精神症状（相对危险比：6.543；P = 0.001）和女性（相对危险比：4.563；P = 0.010）是首次CRM失败的危险因素。此外，有精神症状的BPPV患者（比值比：9.184，P = 0.008）在成功手法复位后的前6个月内复发的可能性显著更高。
焦虑抑郁状态显著降低首次CRM的疗效并增加复发风险。其他因素，如女性和非PSC受累也是BPPV患者需要多次治疗及恢复延迟的易感危险因素。对BPPV患者进行精神症状筛查并积极治疗这些症状，将有助于医生和患者了解和改善疾病预后及治疗选择。
