Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Nancy Reid, MHA, DMSc, PA-C



Objective: Vestibular dysfunction, usually presenting with vertigo, dizziness and/or imbalance, is a common disorder with significant effects on morbidity, mortality and quality of life.1 Anxiety plays a prominent role in the failure of some patients to recover from an acute vestibular event, and specifically, in the development of the debilitating, maladaptive disorder now known as Persistent Postural-Perceptual Dizziness (PPPD).2-6

The purpose of this literature review is to determine if evidence exists to show that early screening and treatment of anxiety can be used in patients with acute vestibular dysfunction to decrease the incidence of PPPD and accompanying disability.

Review Method: A literature search was performed using PubMed and Google Scholar, selecting articles within the past 5 years from peer-reviewed journals. Using the Keywords listed below, this search revealed over 250 articles for review, and twenty-two were selected as the core for this systematic review, based on relevance and quality of the article.

Results: The literature demonstrates that anxiety as a key component in the progression of an acute vestibulopathy to the development of debilitating PPPD. Treatment for PPPD includes anti-anxiety serotonergic medications (SSRI and SNRIs, predominantly), vestibular rehabilitation and cognitive behavioral therapy.

Conclusion: PPPD is now considered to be the third most common cause of chronic dizziness. To date, there are no published studies investigating the possible benefit of early screening and treatment of anxiety in individuals with acute vestibulopathy with the purpose of preventing PPPD. Considering the relative ease of administration of a screening questionnaire for anxiety, and the disabling consequences of PPPD, further investigation of early intervention is recommended.


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