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  • Anxiety and vestibular dysfunction - a review

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    Old 03-22-2004, 05:12 PM   #1
    studyin
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    Anxiety and vestibular dysfunction - a review

    Hi All,

    Last night I got onto Medline and decided to have a good look at the evidence out there with regards to anxiety and vestibular disorders. If I had a dollar for everytime a professional/friend told me, "your anxiety is causing your dizziness/vertigo", I'd be rich. So I decided to see what was out there to support the opposite - that vestibular disorders fuel and drive the anxiety. At least that's how I feel it works with me and I know many of you feel the same.

    This one was the most interesting:

    Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety.Simon et al. Annals of Clinical Psychiatry1998.

    Quote:
    There are 3 models proposed:

    Psychosomatic model: describes vestibular dysfunction as a consequence of anxiety. Hyperventilation and hyperarousal increase vestibulo-ocular reflex sensitivity, even among normals who hyperventilate. No studies have examined vestibular dysfunction during a panic attack.

    Somatopsychic model: proposes that cases of panic disorder are triggered by misinterpreted internal stimuli (eg. stimuli from vestibuar dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.

    Network alarm theory: derives from pharmacological challenge studies and other laboratory assessments of panic that suggest involvement of noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be one potential trigger. The network alarm model contributes to a neuropsychiatric explanation for the somatopsychic model.
    So there you have it, at least two models from the literature that support lab or other inner ear problems potentially driving anxiety and resultant panic attacks. Might help next time you guys visit a "specialist" and need something to back up your views.

    Other articles for those who want to dig further into this are:

    Clark DB, Hirsch BE, Smith MG, Furman JMR, Jacob RG:
    Panic in otolaryngology patients presenting with dizziness or
    hearing loss. Am J Psychiatry 1994; 151:1223-1225

    Jacob R: Panic disorder and the vestibular system. Psychiatr
    Clin North Am 1988; ll(2):361-374

    Jacob RG, Furman JMR, Clark DB, Durrani JD: Vestibular
    symptoms, panic and phobia: Overlap and possible relationships.
    Ann Clin Psychiatry 1992; 4:163-174

    Pratt R, McKenzie W: Anxiety states following vestibular disorders.
    Lancet 1958; 16:347-349

     
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    Old 03-25-2004, 02:25 PM   #2
    PhilMartin
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    Re: Anxiety and vestibular dysfunction - a review

    Hi, Boy are you correct, I go back to 1995. I have lost 80% of my hearing due to nerve damage in the inner ear, which is served by the same endolymphatic fluid as your balance organs. I have had huge problems with anxiety and panic which appeared at the same time as my hearing loss. I now suffer with constant nausea, like a mild flu virus. Fatigue is awful, and sleep non existent. I awake from my very light sleep with heart pounding. The anxiety which incidentally seems impossible to control always seems to be worse at night when I am exhausted, or when I get a cold or flu. The anxiety can be so horendous that my wife takes me to hospital, where of course they tell me Im healthy and send me home. The closest Ive come to any doctor connecting this to my vestibular system is "I wonder if this could be connected to your hearing loss" Very little attempt is made to communicate with me. Im told that my anxiety and resulting depression is psycological. Boy would they be depressed if they lived my half life. I travel 130 miles per day to work by train, which may or may not make me feel nauseated. I am in total agreement that the anxiety that you are experiencing is driven by incorrect signalling from the vestibular system. This anxiety then activates the old "Fight or Flight" syndrome, which leaves you with unwanted adrenalin racing through your system. The result is to me total terror, not panic, total uncontrollable terror! but of course its all "In my head" This is of course in a way true, but not in a perceptive way.
    Perhaps there are others who have similar experience Im not sure, as Im very new to this discussion.
    The cause of my original inner ear damage was viral. I could write a book about symptoms, but this reply is long enough I think. More if you need it, but Im a long term permanent case, which is not good news for others I know. The good news is that Im rare !!!

    Phil

    Last night I got onto Medline and decided to have a good look at the evidence out there with regards to anxiety and vestibular disorders. If I had a dollar for everytime a professional/friend told me, "your anxiety is causing your dizziness/vertigo", I'd be rich. So I decided to see what was out there to support the opposite - that vestibular disorders fuel and drive the anxiety. At least that's how I feel it works with me and I know many of you feel the same.

    This one was the most interesting:

    Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety.Simon et al. Annals of Clinical Psychiatry1998.



    So there you have it, at least two models from the literature that support lab or other inner ear problems potentially driving anxiety and resultant panic attacks. Might help next time you guys visit a "specialist" and need something to back up your views.

    Other articles for those who want to dig further into this are:

    Clark DB, Hirsch BE, Smith MG, Furman JMR, Jacob RG:
    Panic in otolaryngology patients presenting with dizziness or
    hearing loss. Am J Psychiatry 1994; 151:1223-1225

    Jacob R: Panic disorder and the vestibular system. Psychiatr
    Clin North Am 1988; ll(2):361-374

    Jacob RG, Furman JMR, Clark DB, Durrani JD: Vestibular
    symptoms, panic and phobia: Overlap and possible relationships.
    Ann Clin Psychiatry 1992; 4:163-174

    Pratt R, McKenzie W: Anxiety states following vestibular disorders.
    Lancet 1958; 16:347-349[/QUOTE]

     
    Old 03-25-2004, 04:54 PM   #3
    willsmommy
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    Re: Anxiety and vestibular dysfunction - a review

    Hi Scotsman,

    Yeh this is great info and I completely agree that its the vestibular dysfunction that creates the anxiety by exactly the process suggets in the articles. It was a great idea to post this thread and I am gald for once its this way around rather than the - its all in your head stuff that I have heard.

    It does drive me bonkers people who simply have never lived in our shoes for 5 minutes let alone a few months/years as we have! they have no clue at all how it feels. The one good thing I guess I had was an experince with acute anxiety some years ago and I realised straight away that the symptoms I have were not anxiety based at all. They are an entirely different set of sensations and quite frankly not in my worst nightmare could I have dreamed up vertigo, imbalance and all the weird and wonderful sensations that go along with vestinbular dysfunction.

    When you think about it anxiety is completely natural and I would say normal reaction to vestibular dysfunction. i also think that much of the anxiety is the brains automatic reflex to stimuli, for instance if you are glancing down and suddely feel like you have dropped 50 floors the automatic bodily response is an adrenaline rush, much like if you almost hit a car or have to do an emergency stop. These responses are like automatic or beyond our direct control, I guess almost like blushing. Albeit once they occur we can control the anxiety with self talk and abdominal breathing. I also agree completely that anxiety and in turn hyperventilation really amplifies the symptoms, I know that to be the case. I know that if i am not feeling great and push myself and start having lots of fearful thoughts that I can push mild imbalance into super trampoline walk.

    So thanks for the refernces!

     
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