In the present study, many subjects suffering from vertigo were involved. The different diagnoses made it possible to analyse the differences between the several groups. This is of great importance, as a wide range of vertigo disorders is presented at a neurotologic centre. In this study, the patients were not examined in the acute phase of vertigo but rather on an appointment basis; therefore, the distribution of the different diagnoses was quite different than in other investigations [
2], suggesting higher rates of MD and central vestibular disorders and BPPV was only third in the line. According to the results of the DHI questionnaires, 86.4% of the patients have reported impaired QoL, and significantly higher DHI values were detected in patients suffering from central vestibular disorders, VM, PPPD, and other unilateral peripheral vestibulopathies, compared to the results of those suffering from the other disorders. BDI has indicated depression symptoms in 42.3% of the patients, with nearly the same distribution as observed with DHI regarding the diagnoses. Previous investigations have also contrasted the values mentioned above in different disorders. For instance, Goto et al. concluded that depressive disorders were more prevalent in patients with sudden deafness and migraine-associated dizziness [
9]. According to another investigation, patients suffering from central vestibular disorders have reported the highest DHI values, and patients with primer functional dizziness presented significantly higher DHI values than those with peripheral vestibular disorders [
16]. In the present study, the BDI values of those suffering from PPPD and central vestibular disorders were also significantly higher, than the values of the other diagnosis groups. Zhu et al. have concluded that the emotional, physical, and functional aspects of vertigo had more significant effects on patients with VM than those with BPPV. According to their analysis, DHI scores significantly correlated with depression and anxiety scales [
10]. In the present investigation, VM patients also reported significantly higher DHI and BDI values contrasted to other vestibulopathies, including BPPV, which is in concordance with the aforementioned study results. The results of Möhwald et al. indicated significantly higher DHI values in patients with acute peripheral vestibular disorders than with central ones [
17]. This contradicts our results, which have shown significantly lower DHI and BDI values for most peripheral vestibular disorders than central ones. Although, in their study, patients with acute vestibular symptoms examined at the Emergency Department were enrolled, while most of our patients were not in the acute phase of the disorders but were investigated on an appointment basis at a tertiary referral centre. However, our analyses found no correlation between the onset of the symptoms, and therefore the duration of the disorders and DHI and BDI values. MD was defined as the most frequent diagnosis and is known as a chronic, progressive disorder presenting with episodic vertigo. A meta-analysis regarding MD found that about 50% of the patients suffer from depression [
18]. QoL worsening in MD patients caused by the disorder was also reported [
19,
20]. Moreover, a study concluded that vertigo complaints were the most intrusive symptoms, surpassing other MD symptoms, just like tinnitus or hearing loss. Additionally, vertigo was most strongly associated with depression and DHI scores [
19]. Previous studies showed an increased prevalence of affective disorders in episodic vertigo disorders compared to vestibulopathies with non-episodic vertigo complaints [
21]. In the present investigation, patients with episodic (i.e., MD, BPPV, and VM) and acute or chronic persistent (i.e., central vestibular disorders, PPPD, VN, and unilateral peripheral vestibulopathies) symptoms were also enrolled; however, higher DHI and BDI values were found in the non-episodic vertigo syndromes group. This is in contrast with previous findings and highlights the complexity of the background of the QoL impairment and psychiatric symptoms. According to previous findings, VN also significantly affects the patients’ QoL; a moderate impact was reported [
22].
The differences in the DHI and BDI values amongst the different disorders cannot be explained only by the vestibular deficit caused by them. As previously reported, there is no correlation between the severity of the vestibular hypofunction, based on objective vestibular testing and QoL and depressive or anxiety symptoms. A study has concluded that the symptom severity and DHI values were not correlated with the results of clinical vestibular tests but corresponded with several psychological factors (i.e., depression, anxiety, cognitive and behavioural responses etc.) [
23]. Another study observed no correlation between the DHI scores and high- and low-frequency vestibulo-ocular reflex deficits, respectively. Patients suffering from central vestibular disorders were found to report the highest DHI values, and functional dizziness also showed higher DHI values, contrasted to those suffering from peripheral vestibular disorders. In conclusion, it was stated that more than 96.5% of the DHI score variances resulted from unaccounted factors, just like central compensation or neurocognitive behavioural factors [
16]. After vestibular deficits, central compensation is a highly complex and vital process [
24]. Central vestibular compensation involves several anatomical structures of the central nervous system (i.e., vestibular nuclei, vestibulocerebellum, midbrain, dorsolateral/anterior thalamic nuclei, and posterior inferior vestibular cortex) [
25], and is influenced by other factors, including behavioural strategies, socio-cultural background, age, physical activity, etc. Vertigo or dizziness influences everyday tasks and can result in psychosocial consequences. Moreover, somatisation, i.e., the increased attention to the symptoms, can also be responsible for a worsened handicap [
26]. Individual coping strategies have also been suspected to be responsible for differences between vestibular tests and the handicap of the patients [
27]. The factors mentioned above can influence the central compensation and, therefore, the QoL and occurrence of psychiatric comorbidities, independently from the objective results of the vestibular tests. Hence, although QoL questionnaires and psychiatric symptoms are not specific or sensitive to any vestibular disorders, and therefore, they cannot replace vestibular testing, they still can provide important information regarding the functional and psychological difficulties of vertiginous patients.
A limitation of the present study can be that the result of the previous psychiatric/psychological examinations was not considered. Therefore, it was not investigated whether the patient has two simultaneous disorders. Although, since all vertigo patients have filled the questionnaires, this population was examined in detail.