Clinical Manifestation and Prognostic Factors of Chronic Dizziness Due to Long-Term Use of Vestibular Suppressant
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Background and Objectives Dimenhydrinate and benzodiazepine are widely used for theprevention of nausea and vomiting in a variety of acute vestibular diseases. Due to the prolon-gation of central compensatory mechanism and dependency, the long-term use of vestibularsuppressants can elicit various atypical vestibular symptoms and vestibular function test(VFT) results, which result in neglect and underdiagnosis. This study aimed to investigate theeffect of long-term use of vestibular suppressants and identify significant prognostic factors. Subjects and Method Thirty-two patients diagnosed with vestibular suppressant drug as-sociated dizziness (DAD) were enrolled. The patients were instructed to discontinue the sup-pressants and undergo vestibular rehabilitation therapy. The severity of dizziness, complianceto treatment, prognosis, and the results of VFT were evaluated. Results Most of the patients (65.6%) complained of spinning vertigo while some of the pa-tients (25.0%) complained of unsteadiness, directional pulsion, or non-vertiginous dizziness,making the diagnosis difficult. The severity of the DAD symptoms was dependent on the pre-ceding vestibular disorder: it was significantly milder when the preceding vestibular disorderwas benign paroxysmal positional vertigo. Atypical findings of VFT that cannot be fully ex-plained based on known vestibular disorders were frequently observed (9.4%-54.5%). Preced-ing vestibular disorders of old age, non-compliance with vestibular rehabilitation and vestibu-lar neuritis were found to be independent bad prognostic factors. Conclusion Understanding and being aware of DAD as a cause of dizziness may help pa-tients suffering from chronic dizziness without a certain diagnosis.
Abstract
Background and Objectives Dimenhydrinate and benzodiazepine are widely used for theprevention of nausea and vomiting in a variety of acute vestibular diseases. Due to the prolon-gation of central compensatory mechanism and dependency, the long-term use of vestibularsuppressants can elicit various atypical vestibular symptoms and vestibular function test(VFT) results, which result in neglect and underdiagnosis. This study aimed to investigate theeffect of long-term use of vestibular suppressants and identify significant prognostic factors. Subjects and Method Thirty-two patients diagnosed with vestibular suppressant drug as-sociated dizziness (DAD) were enrolled. The patients were instructed to discontinue the sup-pressants and undergo vestibular rehabilitation therapy. The severity of dizziness, complianceto treatment, prognosis, and the results of VFT were evaluated. Results Most of the patients (65.6%) complained of spinning vertigo while some of the pa-tients (25.0%) complained of unsteadiness, directional pulsion, or non-vertiginous dizziness,making the diagnosis difficult. The severity of the DAD symptoms was dependent on the pre-ceding vestibular disorder: it was significantly milder when the preceding vestibular disorderwas benign paroxysmal positional vertigo. Atypical findings of VFT that cannot be fully ex-plained based on known vestibular disorders were frequently observed (9.4%-54.5%). Preced-ing vestibular disorders of old age, non-compliance with vestibular rehabilitation and vestibu-lar neuritis were found to be independent bad prognostic factors. Conclusion Understanding and being aware of DAD as a cause of dizziness may help pa-tients suffering from chronic dizziness without a certain diagnosis.
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