We know that epidemiology studies are influenced by the person or specialty performing the study. For example, ear specialists will find vestibular disorders as the cause for the complaint of dizziness more often than will primary care physicians. Is this because of the tests performed or simply the perspective of the examiner?
Well, you won’t find it if you ain’t looking for it.
As I listen to patients describe their symptoms, I am mentally putting them into one of three boxes:
1. Sounds like a vestibular disorder
2. Doesn’t sound like a vestibular disorder, sounds more like this or that
3. Not clear, better just start testing and see where it leads.
It’s all about attitude
I can’t help but bring my ‘Vestibular Hunter Geek’ perspective with me when I hear or read about symptoms that someone may lump under the way-too-broad classification of ‘dizziness’. In the back of my mind, I am always thinking, “How could an undiagnosed vestibular disorder cause that complaint?”
Here’s one example. It is interesting that The Anxiety and Phobia Workbook (Bourne, 1995) includes the following quote regarding agoraphobia:
“It is common for the agoraphobic to avoid a variety of situations. Some of these include: (1) Crowded public places such as grocery stores, department stores, restaurants, (2) Enclosed or confined places such as tunnels, bridges, or the hairdresser’s chair, (3) Public transportation such as trains, subways, planes, (4) Being home alone.”
Many of these situations sound strikingly familiar to the complaints of patients with vestibular loss, particularly ‘fear of crowded spaces’ (vestibular patients often become overly dependent on visual information and can become uneasy or disoriented when exposed to moving visual fields), ‘tunnels’ ( the closed quarters and lighting inside a tunnel can create an optokinetic effect that can affect visual stability, and is also frequently bothersome to migrainers), and the ‘hairdressers chair’ (BPPV patients often report episodes of vertigo when they are laid back in a hairdresser’s chair).
It seems possible that some patients diagnosed with panic and anxiety disorder may have an undiagnosed contributing vestibular disorder. Currently, this is pure speculation, and structured clinical studies would be required before any conclusions can be drawn.