Clinical Feature And Management Of Persistent Postural-Perception Dizziness

Background:Dizziness is one of the most common symptoms in otology outpatient.Some patients have organic vestibular disorders,for example,meniere disease,BPPV,vestibular neuronitis,vestibular migraine.while the other patients have no obvious organic disease,with the normal neurological findings in vestibular and balance test result,this type is named psychogenic dizziness.Psychogenic dizziness account for a large proportion of the complex forms of dizziness syndromes.In the course of their complex dizziness syndromes,about 70% of these patients still complain about symptoms,even after several years.They are more impaired in their professional and daily activities than patients with organic forms of dizziness.Persistent posturalperception dizziness is a common type of psychogenic dizziness,it is a condition of persistent,non-vertiginous dizziness or unsteadiness lasting 3 months or more,which is exacerbated by upright posture,an individual’s own motion,objects moving in the environment,and exposure to complex visual stimuli.PPPD was defined by the WHO 11 th beta draft of International Classification of Diseases in 2015,but there has fewer research about PPPD in China.Therefore,it is particularly important to realize the clinical features,pathogenesis and therapy of PPPD exactly.Part 1 Clinical feature of the Persistent Postural-perception Dizziness Objective:To explore the clinical feature of patients with persistent postural-perception dizziness.Methods:39 patients with PPPD chosen from the Department of Otology of the First Affiliated Hospital of Zhengzhou University from October 2015 to February 2017.The control group included 36 cases of hospitalized patients who had experienced the sudden hearing loss with vertigo from the same period.The clinical data and the result of Dizziness Handicap Inventory(DHI),Somatic symptom rating scale,NEO Five-Factor Inventory(NEO-FFI),audiology and vestibular test were collected and analyzed.Result:In the study group,the proportion of men and women was 1: 2.55,and the average age of onset was 51.18 ± 11.53 years old.The average score of Dizziness Handicap Inventory(DHI)was higher than that in the control group,the difference was statistically significant(P <0.05).In the NEO Five-Factor Inventory(NEO-FFI),the mean score of neuroticism was higher than in the control group,and the mean score of extroversion and agreeableness were lower than that of the control group,the difference was statistically significant(P <0.05).In the Somatic symptom rating scale,the total score of the study group,the score of the suppression somatic symptom,the irritation somatic symptom,the imagine somatic symptom and the cognitive somatic symptom were higher than the control group,the difference was statistically significant(P <0.05).Conclusion:The patients with PPPD had a higher prevalence of females,the age of onset was 41 to 60 years old.PPPD were more impaired in the patients’ professional and daily activities.The personality traits of neuroticism and introversion were the risk fators for the onset of PPPD,and anxiety was the main mood disorder to be identified.Part 2 Management of Persistent Postural-perception dizziness Objective:To explore the management of persistent postural-perception dizziness.Methods:39 patients with PPPD were divided into three groups.13 patients in the group of psychogenic PPPD,18 patients in the group of otogenic PPPD and 8 patients in the interactive PPPD.The treatment of all the patients including medication,vestibular and balance rehabilitation therapy.All the patients were followed up for four weeks and post treatment at 4th weeks were assessed by Dizziness Handicap Inventory(DHI),Somatic symptom rating scale.Exploring and analyzing the difference of therapeutic effect in each group of PPPD.Result:Before treatment,the mean scores of the Dizziness Handicap Inventory(DHI)and Somatic symptom rating scale in the three groups were higher than those of 4 weeks after treatment,the difference was statistically significant(P <0.05).Before treatment,the mean scores of the Dizziness Handicap Inventory(DHI)and Somatic symptom rating scale were no statistically significant difference between every two groups(P> 0.05).The mean scores of the Dizziness Handicap Inventory(DHI)and Somatic symptom rating scale were also no statistically significant difference between every two groups 4 weeks after treatment(P> 0.05).Conclusion:The treatment including medication,vestibular and balance rehabilitation therapy can significantly improve the symptoms of the patients with PPPD.The therapeutic effect of PPPD had no difference after the same treatment.