State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma

Yougan Saman; Lucie Mclellan; Laurence Mckenna; Mayank B Dutia; Rupert Obholzer; Gerald Libby; Michael Gleeson; Doris-Eva Bamiou

doi:10.3389/fneur.2016.00101

State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma

Front Neurol. 2016 Jul 13:7:101. doi: 10.3389/fneur.2016.00101. eCollection 2016.

Authors

Yougan Saman¹, Lucie Mclellan², Laurence Mckenna³, Mayank B Dutia⁴, Rupert Obholzer⁵, Gerald Libby⁶, Michael Gleeson⁷, Doris-Eva Bamiou⁸

Affiliations

¹ Institute of Neurology, National Hospital for Neurology and Neurosurgery, UCL, London, UK; Nelson R. Mandela School of Medicine, UKZN, Durban, South Africa.
² Neuro-otology Department, National Hospital for Neurology and Neurosurgery , London , England.
³ Royal National Throat, Nose and Ear Hospital , London , UK.
⁴ Centre for Integrative Physiology, University of Edinburgh , Edinburgh , UK.
⁵ ENT and Skull Base Department, Guys Hospital, London, UK; ENT and Skull Base Department, Kings College Hospital, London, UK.
⁶ Neurogastroenterology Group, Queen Mary University of London , London , UK.
⁷ Neuro-otology and Skull Base Department, National Hospital for Neurology and Neurosurgery , London , UK.
⁸ Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, England; Ear Institute, UCL, London, UK.

Abstract

Introduction: Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function.

Aims: (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap.

Methods: Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS-VER.

Results: In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001).

Conclusion: Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.

Keywords: anxiety; balance; cognitive behavioral therapy; handicap; vestibular schwannoma.