title: Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.
abstract: OBJECTIVE
  To examine the backgrounds of patients with audiovestibular disease regarding what influences their psychological state.
  
  
  METHODS
  During a 12-year period, 375 successive patients with audiovestibular diseases were enrolled in this study. Diseases included unilateral (n=174) and bilateral (n=51) Menière's disease, sudden deafness with vertigo (n=70), and vestibular neuritis (n=80). Diagnosis, sex, age, duration of disease, vertigo frequency, persistent nystagmus, and ipsilateral/contralateral hearing levels were recorded. Cornell Medical Index (domains III-IV=neurosis) and Self-Rating Depression Scale (score>40=depression) were applied during acute vertigo remissions in all patients.
  
  
  RESULTS
  Neurosis and depression, respectively, were diagnosed in 62.7% and 82.4% of bilateral Menière's, 32.7% and 48.9% of unilateral Menière's, 15.7% and 38.6% of sudden deafness/vertigo, and 12.7% and 31.3% of vestibular neuritis patients. Multivariable logistic regression analysis showed that Menière's disease with longer disease duration (Oz 1.212; P=0.021) and worse hearing in the secondary affected ear (Oz 1.131; P=0.042); sudden deafness/vertigo with persistent nystagmus (Oz 1.895; P=0.005); and vestibular neuritis with longer disease duration (Oz 1.422; P=0.019) and persistent nystagmus (Oz 1.950; P=0.0003) had mental illness significantly more often than those with shorter-duration disease, better hearing and no persistent nystagmus.
  
  
  CONCLUSIONS
  Mental disorder increased in accordance with solo vertigo, vertigo/hearing loss, repeated symptoms, and bilateral lesions. Treatment strategies should be carefully constructed for patients with persistent nystagmus, long disease duration, and hearing loss in the secondary affected ear to avoid psychological disorders.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Sakagami
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. Electronic address: tkitahara@naramed-u.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitahara
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Okayasu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Yamashita
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Hasukawa
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ota
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D003639:Hearing Loss, Sudden / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008575:Meniere Disease / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009759:Nystagmus, Pathologic / Q000523:psychology*; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D014717:Vertigo / Q000523:psychology*; D020338:Vestibular Neuronitis / Q000523:psychology*
keywords: Contralateral hearing level; Dizziness; Duration of disease; Mental illness; Persistent nystagmus