Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of the Effectiveness of Vestibular Rehabilitation and Venlafaxine in the Treatment of Patients with Persistent Postural-Perceptual Dizziness, a Randomized Clinical Trial

Document Type : Original Article (s)

Authors
Seyed Hamidreza Abtahi 1
Narges Askari Sabzkouhi 2
Mohammad Hossein Nilforoush 3
Niloofar Tarbiat Nobari 2
1 Associate Professor, Department of Otolaryngology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Otolaryngology, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v43.i809.0283
Abstract
Background: This study aimed to investigate the efficacy of venlafaxine as a first-line treatment for patients with persistent postural-perceptual dizziness (PPPD) and compare the superiority of vestibulo-ocular rehabilitation versus venlafaxine in PPPD patients.
Methods: A randomized clinical trial was conducted on sixty patients (31 males, 29 female) with a mean age of 43 ± 9.9 years, diagnosed with PPPD by Bárány criteria at Al-Zahra Hospital in Isfahan, Iran, from September 2023 to March 2024. Patients were randomly divided into two groups of 30 people each. One group received vestibulo-ocular reflex rehabilitation once a week for six weeks, and the other group received venlafaxine 37.5 mg daily for six weeks. Dizziness severity was measured pre/post-intervention using the Dizziness Handicap Inventory (DHI).
Findings: In the vestibular-ocular rehabilitation group, the mean DHI score before intervention was 46.33 ± 13.65, which reduced to 28.26 ± 12.64 after intervention. In the medical treatment group, the mean DHI score was 47.86 ± 13.57, which dropped to 28.13 ± 10.58 after treatment. Both groups showed significant reductions in DHI scores after treatment (P < 0.001), with no superiority between treatments (P > 0.05).
Conclusion: Venlafaxine can be used as a first-line treatment for patients with PPPD. No superiority was found for vestibular-ocular rehabilitation over venlafaxine in treating PPPD.

Highlights

Seyed Hamidreza Abtahi: Google Scholar 

Mohammad Hussein Nilforoush: Google Scholar  

Keywords
Rehabilitation
Dizziness
Venlafaxine

Subjects

  1. Murdin L, Schilder AGM. Epidemiology of balance symptoms and disorders in the community. a systematic review. Otol Neurotol 2015; 36(3): 387-92.
  2. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual Dizziness (PPPD): a common, characteristic and treatable cause of chronic Dizziness. Pract Neurol 2018; 18(1): 5-13.
  3. Powell G, Derry-Sumner H, Rajenderkumar D, Rushton SK, Sumner P. Persistent postural perceptual Dizziness is on a spectrum in the general population. Neurology 2020; 94(18): e1929-e1938.
  4. Strupp M, Glaser M, Karch C, Rettinger N, Dieterich M, Brandt T. The most common form of Dizziness in middle age: phobic postural vertigo [in German]. Nervenarzt 2003; 74(10): 911-4.
  5. Staab JP. Persistent postural-perceptual Dizziness. Semin Neurol 2020; 40(1): 130-7.
  6. Bittar RSM, von Söhsten Lins EMD. Clinical characteristics of patients with persistent postural-perceptual Dizziness. Braz J Otorhinolaryngol 2015; 81(3): 276-82.
  7. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, et al. Diagnostic criteria for persistent postural-perceptual Dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 2017; 27(4): 191-208.
  8. Staab JP, Ruckenstein MJ. Which comes first? Psychogenic Dizziness versus otogenic anxiety. Laryngoscope 2003; 113(10): 1714-8.
  9. Yan Z, Cui L, Yu T, Liang H, Wang Y, Chen C. Analysis of the characteristics of persistent postural-perceptual Dizziness: a clinical-based study in China. International Journal of Audiology 2016; 6(1): 33-7.
  10. Kim SK, Kim YB, Park IS, Hong SJ, Kim H, Hong SM. Clinical analysis of dizzy patients with high levels of depression and anxiety. J Audiol Otol 2016; 20(3): 174-8.
  11. Ketola S, Havia M, Appelberg B, Kentala E. Depressive symptoms underestimated in vertiginous patients. Otolaryngol Head Neck Surg 2007; 137(2): 312-5.
  12. Staab JP. Chronic subjective Dizziness. Continuum (Minneap Minn) 2012; 18(5 Neuro-otology): 1118-41.
  13. Staab JP, Rohe DE, Eggers SD, Shepard NT. Anxious, introverted personality traits in patients with chronic subjective Dizziness. J Psychosom Res 2014; 76(1): 80-3.
  14. Whitney SL, Alghwiri AA, Alghadir A. An overview of vestibular rehabilitation. Handb Clin Neurol 2016; 137: 187-205.
  15. Staab JP. Behavioral aspects of vestibular rehabilitation. NeuroRehabilitation 2011; 29(2): 179-83.
  16. Kuwabara J, Kondo M, Kabaya K, Watanabe W, Shiraishi N, Sakai M, et al. Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual Dizziness: A pilot Am J Otolaryngol 2020; 41(6): 102609.
  17. Thompson KJ, Goetting JC, Staab JP, et al. Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual Dizziness:a pilot study. J Vestib Res 2015; 25(2): 97-104.
  18. Tramontano M, Princi AA, Angelis SD, Indovina L, Manzari L. Vestibular rehabilitation in patients with persistent postural-perceptual dizziness: s scoping review. Hearing, Balance and Communication 2021; 19(4): 282-90.
  19. Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don’t forget vestibular rehabilitation. Expert Rev Neurother 2022; 22(8): 669-80.
  20. Herdman SJ, Clendaniel R. Vestibular Rehabilitation. 4th Philadelphia: F.A. Davis Company; 2014. p. 656.
  21. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the Dizziness handicap inventory. J Res Med Sci 2014; 19(8): 769-75.
  22. Radhakrishna K, Gaughan M. Persistent postural perceptual dizziness in the Neurology Clinic. Ir Med J 2024; 117(8): 1024.
  23. Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American Physical Therapy Association Neurology Section. J Neurol Phys Ther 2016; 40(2): 124-55.
  24. Webster KE, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Ray J, et al. Pharmacological interventions for persistent postural-perceptual dizziness (PPPD). Cochrane Database Syst Rev 2023; 3(3): CD015188.
  25. Min S, Kim JS, Park HY. Predictors of treatment response to pharmacotherapy in patients with persistent postural-perceptual dizziness. J Neurol 2021; 268(7): 2523-32.
  26. Trinidade A, Goebel JA. Persistent Postural-Perceptual Dizziness-A Systematic Review of the Literature for the Balance Specialist. Otol Neurotol 2018; 39(10): 1291-303.
  27. Popkirov S, Stone J, Holle-Lee D. Treatment of Persistent Postural-Perceptual Dizziness (PPPD) and Related Disorders. Curr Treat Options Neurol 2018; 20(12): 50.
  28. Axer H, Finn S, Wassermann A, Guntinas-Lichius O, Klinger C, Witte O. Multimodal treatment of persistent postural-perceptual dizziness. Brain Behav 2020; 10(12): e1864.
  29. Ibrahim NMK, Hazza NMA, Yaseen DM, Galal EM. Effect of vestibular rehabilitation games in patients with persistent postural perceptual dizziness and its relation to anxiety and depression: prospective study. Eur Arch Otorhinolaryngol 2024; 281(6): 2861-9.
  30. Nada EH, Ibraheem OA, Hassaan MR. Vestibular rehabilitation therapy outcomes in patients with persistent postural-perceptual dizziness. Ann Otol Rhinol Laryngol 2019; 128(4): 323-9.
Journal of Isfahan Medical School
Volume 43, Issue 809
1st Week, June
May and June 2025
Pages 284-292

  • Receive Date 28 May 2024
  • Accept Date 01 June 2025