Factors Associated With Dizziness Among Patients With Vestibular Schwannoma

Importance Patients with vestibular schwannoma (VS) commonly present with neurological symptoms such as hearing loss, tinnitus, and dizziness. However, factors associated with dizziness at presentation are not well understood. Objective To evaluate the baseline features of adults diagnosed with VS associated with subjective dizziness using a validated instrument. Design, Setting, and Participants This retrospective cohort study included adults with radiologically diagnosed VS who completed vestibular testing at Washington University (St Louis, Missouri) between June 2004 and January 2025. Baseline dizziness was measured using the Dizziness Handicap Inventory (DHI). Exposures Anxiety associated with a VS diagnosis. Main Outcomes and Measures The primary outcome was severity of dizziness based on DHI score. Results A total of 109 patients were included; the mean (SD) age was 61 (14) years, 57 (52%) were female, and 52 (48%) were male. The mean (SD) DHI score was 27 (24) points. Participants with a history of anxiety had a DHI score that was 13.7 points (95% CI, 4.2-23.2 points) higher than those with no such history. For every additional point in severity of anxiety measured using the Generalized Anxiety Disorder-7 (GAD-7) scale, DHI score increased 2.6 points (95% CI, 2.0-3.3 points). After controlling for covariates, for every 1-point increase in GAD-7, DHI score increased by a mean of 1.9 points (95% CI, 1.3-2.6 points). On average, patients with a history of anxiety had a DHI score 10.6 points (95% CI, 2.4-18.7 points) higher than those with no such history. Conclusions and Relevance This retrospective cohort study suggests a psychological association between anxiety and dizziness might exist among patients with VS that has not previously been explored. Further studies examining this association are needed in this patient population.