No abstract

Questionnaires assessing symptoms, disability and handicap, predisposition to anxiety, and current anxiety and depression were completed by 127 people attending neuro-otology clinics with a major complaint of vertigo or dysequilibrium. Definite signs of vestibular dysfunction (spontaneous or positional nystagmus, or canal paresis) were found in 56% of the sample, but the presence or absence of abnormal vestibular test results was unrelated to diagnosis, reported symptoms, handicap and psychological status. Two-thirds of employed respondents admitted to occupational difficulties, and more than one in seven had left work because of vertigo. Although the number of people in the sample with a predisposition to anxiety was not unusually high, over a third of the sample had abnormally elevated levels of current anxiety. Multiple regression analyses indicated that disability was determined mainly by physical factors (vertigo severity and duration, age and sex). Handicap was influenced by a mixture of somatic and psychological variables, including the severity of autonomic symptoms. Anxiety and depression were only indirectly related to the severity and duration of the vertigo, insofar as this contributed to handicap. The partial dissociation between these different aspects of patient well-being suggests a need for separate evaluation and differing management of problems at each level of functioning.

In a prospective longitudinal study of the relationship between symptoms and anxiety in people with vertigo, 101 patients were evaluated on two occasions separated by a 7 month interval. At Time 1 the age, gender, vertigo type, duration of illness, medication, and audiovestibular test results of patients were recorded, and they completed questionnaires assessing handicap, emotional distress, predisposition to anxiety, and symptoms indicative of vertigo and of somatic anxiety. These questionnaires were re-administered at Time 2, and patients also indicated whether their vertigo was more or less severe than at Time 1. Although vertiginous symptoms at Time 2 were generally mild and intermittent, they were associated with significant handicap. Reported symptoms of somatic anxiety and arousal at Time 1 proved to be the only longitudinal predictors of perceived change in vertigo severity over the 7 month period.

Mondini dysplasia is a congenital malformation of the inner ear. To date, five individuals with this malformation have received cochlear implants at the South of England Cochlear Implant Centre. The aim of this study was to review the audiological findings of these individuals after implantation. The soundfield thresholds after implantation are in the region of 30-40 dB (A). The results of suprathreshold speech recognition tasks show substantial variability in performance but this is no greater than that obtained from implant users with no malformation. All individuals were able to detect and recognize a variety of environmental sounds that would previously have been inaudible. These findings, along with the reported improvement in quality of life, mean that Mondini dysplasia is not a contra-indication for multichannel cochlear implantation. This information will be useful to other centres when considering implantation in similar patients.

Stapedectomy in children has long been regarded as taboo and published accounts of this surgery in this age group are few. This paper presents a small series of 29 stapedectomies in patients aged 21 or less; 19 for otosclerosis, 10 for other pathologies associated with stapedial fixation. The results on the otosclerotic group (17 [89%] success, 2 no change, 0 sensorineural loss) were comparable with stapedectomy in adults. The results in the non-otosclerotic group (5 better, 2 no change, 3 sensorineural losses) were not satisfactory, and stapedectomy for stapedial fixation caused by conditions other than otosclerosis cannot be recommended in this age group.