Saman, Y; (2014) Balance Dysfunction in Vestibular Schwannoma Patients. Doctoral thesis , UCL (University College London).

Abstract

Background In vestibular schwannoma (VS) important clinical questions such as whether balance symptom severity and loss of mobility affect quality of life, or whether surgery worsens balance function remain inadequately answered. The relationship between an objective balance deficit and subjective balance dysfunction is unclear. Factors affecting vestibular compensation like anxiety and stress have yet to be clearly defined as relevant in symptom exacerbation. Studies are often hampered by the limitations of retrospective series, poor controls and the inadequate use of validated standardised assessment tools. In this study standardised validated tools were used to prospectively measure subjective, objective and functional balance outcomes in VS. Aims To investigate balance dysfunction and the factors responsible for poor compensation in the VS population using validated assessment tools. Methods Patients were recruited from the National Hospital for Neurology and Neurosurgery and Guy’s Hospital. Balance was assessed using an objective vestibular test battery and questionnaires. Psychological symptoms were assessed using questionnaires and the stress response was measured in relation to vestibular testing. Results Balance symptom severity, ambulant posture, and anxiety were significant contributors to balance related handicap. While symptoms were not as severe as in other neuro-otological cohorts they were nonetheless worse than in healthy controls. There was little correlation between the presence of an objective balance deficit and the severity of balance dysfunction. Anxiety and stress may be important factors in vestibular compensation. Surgery was not found to be a significant predictor of balance related outcomes. Conclusions This study has identified and measured factors that contribute to balance dysfunction in VS patients using validated standardised tools and provides information that could inform vestibular rehabilitation strategies. Attention is drawn to the relative roles of the severity of balance symptoms, objective vestibular deficits, dysfunction of posture and mobility, and anxiety and stress in balance related handicap.

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