What is the relationship between stress and vertigo?

In our practice we see many patients with vertigo. They are often referred for a VNG, or balance test. Many of them have a viral infection of the inner ear that results in dizziness that will resolve itself in a few months. Some of them have benign positional vertigo that will go away with a simple procedure to reposition the little stone in their ear that has gone astray. Some patients have chronic difficulties that are more of a mystery.

A substantial part of any VNG is the interview. We talk with patients about the history of their balance problems and their stress level. We ask whether or not they perceive they have difficulty with feeling anxious. While these might seem to be questions out of left field, they are not. Furman and Jacob lay out a series of links between anxiety and vertigo. To adequately assist dizzy patients we use these links to understand the role of anxiety and how it influences sensations of dizziness.

The first link is that of dizziness cause purely by anxiety due to hyperventilation-induced vertigo during panic attacks or near panic attacks. When one feels anxiety, breathing becomes shallow and rapid, reducing the oxygen available in the bloodstream. This causes a sensation of lightheadedness. This lightheadedness is noted by the individual as a source of concern, which causes more rapid and shallow breathing and the cycle spirals down to a full blown attack of dizziness and possibly panic.

The second link is a chance occurrence of anxiety and vertigo in the same patient. Anxiety may not contribute to the presence of vertigo in any significant way.

The third link relates to problematic coping skills with balance symptoms. On the most basic level, if one has a prolonged dizzy attack it is a very bad experience. The next time that sensation presents itself, it is natural to respond with fear that it will be as bad as last time. This response is rational and to be expected. One can be the calmest soul in the world and the presence of vertigo in your life can make you anxious. Support and understanding can help to relieve some of this stress.

The fourth link provides psychological explanations for the relationship between anxiety and vertigo. This refers back to the fixation of some patients on body sensation. If hyperventilation leads to slight dizziness, the tendency to fixate on the sensation will cause it to become more prominent both in the mind and in reality as a result of hyperventilation.

Finally there is the neurological linkage that focuses on the overlap in the circuitry of our brains involved in balance disorders and anxiety disorders. In a study by CD Balaban and JF Thayer published in the Journal of Anxiety Disorders in 2001, a review of scientific literature revealed a relationship based on shared pathways that control vestibular function and somatic and visceral sensory information processing. This means that the parts of your brain that help you interpret incoming balance information from your vestibule, a part of the cochlea, also process information that appears to be involved in avoidance, anxiety and conditioned fear. One can be forgiven for thinking that this is not nature’s most perfect design.

Researchers have indicated that chronic subjective dizziness is consistent with advancing research on anxiety and somatoform illness and offers greater insights into the relationships between neuro-otologic illness (tinnitus, hyperacusis and balance disorder) and anxiety.

When you come to us for a balance assessment, we will be thinking of you as a whole person with balance problems. You are not just a pair of ears. To help your doctor help you, we always keep in mind these important links between the mind and the ear.

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