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Behavioural Neuro-Otology 

Behavioural Neuro-Otology
Chapter:
Behavioural Neuro-Otology
Author(s):

Jeffrey P. Staab

DOI:
10.1093/med/9780199608997.003.0030
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date: 05 December 2019

Medical writings dating back over 140 years contain detailed descriptions of behavioral factors in patients with vestibular symptoms. Many of these observations were lost in the dichotomous approach to medicine and psychiatry that dominated 20th century medical thought. Research conducted over the last 25 years provides sufficient data to abolish dichotomous models in neurotology and develop integrated paradigms of normal locomotion and vestibular diseases that incorporate behavioural factors such as threat, anxiety, depression and functional disorders into clinical care and research. A growing number of neurotology centers around the world are managing patient care in a fully integrated fashion, incorporating simple, but effective, procedures for identifying behavioral morbidity into their regular workflow. Strategies are available to accomplish this task with little disruption to existing care processes. The return for patients is astounding, particularly when the dichotomous thinking of the last century is left there. Clinically significant anxiety and depression afflict 30-50% of patients with vestibular symptoms. Sometimes these behavioral factors are the primary cause of patients’ complaints. More often, they complicate the clinical picture and can adversely affect medical and surgical management, if not incorporated into integrated care plans. The clinical syndrome of phobic postural vertigo (PPV) was first described in 1986. Its streamlined reincarnation, chronic subjective dizziness (CSD), was defined in 2007. Investigations have revealed much about their triggers, clinical course, and treatment. A consolidated definition is being developed. When properly recognized, PPV/CSD is the second most common, and one of the most treatable, vestibular disorders in tertiary neurotology.

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