Association between vertigo severity, psychological distress, and health-related quality of life in patients with acute sensorineural hearing loss: A cross-sectional retrospective analysis.

BACKGROUND

This study assessed whether initial vertigo severity in acute sensorineural hearing loss (ASNHL) is associated with increased anxiety, depression, and reduced health-related quality of life and functioning within a psychosomatic framework.

METHODS

We performed a cross-sectional retrospective analysis of 187 ASNHL patients treated at a tertiary center from January 2022 to December 2024. Patients were stratified by initial Dizziness Handicap Inventory (DHI) into No/Mild (≤30), Moderate (31-60), and Severe (>60) vertigo. Outcomes included Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the SF-36. Multivariable linear regression adjusted for age, sex, and hearing loss severity (pure tone average, PTA). A sensitivity analysis using the DHI-Physical subscale was conducted to control for conceptual overlap between DHI emotional items and psychological outcomes.

RESULTS

A robust dose-response relationship emerged: increasing vertigo severity was associated with higher anxiety (HAMA mean 8.9, 15.6, 23.1) and depression (HAMD 7.5, 14.2, 21.8) scores (P < 0.001), and progressive declines across all SF-36 domains (P < 0.001). After adjustment, severe vertigo was strongly associated with greater anxiety (β = 12.5, 95% CI 9.8-15.2), greater depression (β = 11.9, 95% CI 9.3-14.5), and lower SF-36 physical component scores (β = -15.8, 95% CI -19.5 to -12.1; all P < 0.001). Sensitivity analysis confirmed that physical vertigo symptoms alone were significantly associated with psychological distress (P < 0.001).

CONCLUSION

Initial vertigo severity is a dominant independent factor associated with psychological distress and impaired QoL in ASNHL, frequently exceeding the impact of hearing loss itself. These findings support a biopsychosocial model of acute vestibular pathology, highlighting the need for early multidisciplinary management.