Anxiety and Dizziness –the Research

Numerous researchers have noted a correlation between vestibular disorders and anxiety or panic disorder.  As noted last week, whether vestibular disorders may lead to panic disorder or whether vestibular complaints are consequential of panic disorder is a subject of much speculation and research. Here is a short summary (with my snarky comments inserted in parentheses) of some research on the subject:

Alvord (1991) noted that “dizzy” patients scheduled for ENG had a much higher self-assessment of anxiety than did their non-dizzy patients scheduled for auditory-evoked potential tests or subjects with no medical complaints. (After seeing both hearing and balance patients for thirty years, I can tell you the anxiety level is MUCH higher for the dizzy patients. Patients with hearing complaints often wait several years before it bothers them enough to seek help. In our balance clinic, the most frequent complaint we get is that it took too long to get an initial appointment).

Hoffman, O’Leary, and Munjack (1994) reported abnormal scores on the vestibular autorotation test on all patients seen in a panic disorder clinic. These patients were not selected or excluded based on a complaint of dizziness. (The authors hypothesized that “the resulting experience of a visual- vestibular disturbance-perhaps in a biologically or psychologically predisposed individual-is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.” While I agree that the thinking here is plausible, it might be a bit of a stretch. At this time, the vestibular autorotation test has not been subjected to the scrutiny of the AMA, and does not have a CPT code assigned to it. While I feel it is a useful test, I would not make a diagnosis of vestibular dysfunction on this test in isolation.)

Jacob (1988) offers a historical perspective on the subject and proposes possible theories as to the cause and effect relationship of panic disorder and the vestibular system: Vestibular evaluations were performed on 21 patients with a history of panic disorder or agoraphobia. He found a high (71 to 75%) incidence of abnormal caloric and posturography scores in these patients. (Abnormal calorics could not be the result of an anxiety disorder, abnormal posturography scores could).

Sklare, Stein, Pikus, and Uhde (1990) also report that 71% of patients with a history of panic disorder had some abnormality on ENG testing. (‘Some’ abnormality on ENG testing is pretty non-specific. In the past, I have seen reports that state “the ENG was abnormal.” What does that mean? To me, it means the person dictating the report has a poor understanding of the various systems being tested in an ENG/VNG battery. Thankfully, I see this rarely these days.)

We will finish up our review of anxiety and dizziness next week.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.

2 Comments

  1. I was deep-dive-snorkeling a lot on a coral reef about 8 years ago without taking good care to adjust ear pressure on the frequent ups and downs. My eardrum busted with only minor pain. I knew it busted because I started swimming sideways as a result of the cold water hitting the cochlea. Then I noticed my hearing was gone…for several weeks. It eventually healed back and the ENT warned me that the high-pitch frequency loss was not going to return and I might have a hole in the vestibular system that can’t really be fixed. I’ve noticed an increasing loss of balance since then, especially the last two years. This year I’ve started waking up with high anxiety, even losing sleep, especially if hungry. Any anxious situation seems greatly amplified, to the point of full-body tremors while laying in bed that are reduced with food and alcohol. I have been trying to determine if I have early onset parkinsons (anxiety like this is often the first sign, and of course balance is affected in parkinsons) or if this is a “hole-in-the-cochlea” problem.

  2. I have a diagnosed anxiety disorder, depression, sleep disorder, CAD, and a vestibular mismatch syndrome. I need a hearing aid in growds because the hearing in one ear is well off, (probably due to the airbag that saved my life). I had another recent rear-end car accident that messed up my balance and vision for several weeks. Today, I tried to walk a block and was hit really hard with vestibular symptoms. I thought I would try a half hour later to walk another short distance and I could feel the anxiety rising. I came home and rested and thought I would be OK to drive to the bank. I was greatly mistaken. I had my first panic attack in years. I had to get back in my car and hope I could get home before I became overwhelmed. Thankfully I had Adivan to help pull me out of this panic feeling. It is very hard to describe and over-powers and though I have that I can manage it. I know it was the walking, which I hadn’t done recently due to the CAD, but I was put on Beta blockers for the irregular beat and I thought I would get back on the horse. I should have taken a much slower approach to re-introducing walking back into my health program. I worked at it with a treadmill for three weeks, but walking on the hills, with my visual problems, I guess made the short walks kick my anxiety into over-drive. After the Adivan kicked in, I was able to complete the drive to the bank, in the company of my son who watched over me in case I was hit hard again. Hope this adds some helpful detail from someone who suffers from panic disorders et al…

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