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Association of Traumatic Brain Injury With Vestibular Dysfunction and Dizziness in Post-9/11 Veterans
Alicia A Swan1, Jeremy T Nelson, Terri K Pogoda
1University of Texas at San Antonio (Dr Swan); Department of Defense Hearing Center of Excellence, Defense Health Agency, San Antonio, Texas (Dr Nelson); Ho-Chunk, Inc, Alexandria, Virginia (Dr Nelson); Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis (Dr Nelson); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Boston University School of Public Health, Boston, Massachusetts (Dr Pogoda); James H. Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Physical Therapy (Dr Hall), East Tennessee State University, Johnson City; Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina (Dr Riska); Center for Health Care Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts (Ms Amuan); Departments of Psychiatry, Neurology and Epidemiology, School of Medicine, University of California San Francisco (Dr Yaffe); Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Dr Pugh); and Department of Internal Medicine, The University of Utah, Salt Lake City (Dr Pugh).
Objective:
To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans.
Setting:
Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA).
Participants:
Post-9/11 veterans with at least 3 years of VA care.
Design:
Cross-sectional, retrospective, observational study.
Main Measures:
International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory.
Results:
Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination.
Conclusions:
There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.
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