PP1411 - Influence of Patient Self-Reported Anxiety on Rotary Chair Test Metrics

Abstract: Rotary chair testing is routinely used to assess vestibular function through measurement of the vestibular ocular reflex (VOR). However, evidence suggests that anxiety and depression may alter VOR responses, potentially complicating interpretation of vestibular test results. This retrospective cohort study examines relationships between self-reported anxiety and depression (GAD-7, PHQ-9) and rotary chair VOR measures (Visual Suppression and Visual Enhancement) in adult patients evaluated at Mayo Clinic Florida. We hypothesize that anxiety will show a positive linear relationship with VOR gain, while depression will show an inverse relationship, informing diagnosis and counseling.

Summary: Rationale/Purpose
Research suggests that mental state, including arousal, anxiety, and panic, can modulate reflexive eye movements and vestibular responses. Individuals with vestibular dysfunction tend to show lower VOR gains, whereas those with anxiety often show heightened responses. Because anxiety is more prevalent among those with vestibular disorders, coexisting conditions may obscure diagnostic findings—reducing the apparent severity of vestibular impairment. Understanding this interaction is critical for accurate clinical interpretation and patient management. Despite its clinical relevance, the relationship between quantified anxiety/depression and specific VOR measures during rotary chair testing has not been well characterized.
Methods
This retrospective cohort study reviewed electronic medical records of patients who underwent diagnostic vestibular evaluations at Mayo Clinic Florida between January 2025 and January 2026. Data extracted from electronic medical records included demographics (age, sex, race/ethnicity), final vestibular diagnoses, and results of standardized questionnaires (GAD-7 and PHQ-9). Rotary chair test data will include VOR gain, phase, and symmetry values for Visual Enhancement (0.16 Hz) and Visual Suppression (0.16 Hz, 0.64 Hz) conditions.
The primary statistical analysis will employ linear mixed-effects modeling to assess relationships between continuous measures of anxiety/depression and VOR responses. In cases where data distribution limits the use of continuous variables, categorical analyses (e.g., median splits) will be performed. If no significant associations are identified, equivalence testing (two one-sided t-tests, TOST) will determine whether the absence of effects represents true equivalence rather than insufficient power. Data collection and analyses will be completed by February 2026.
Results and Conclusions
Although data are currently being collected, we expect to identify patterns suggesting that higher anxiety levels are associated with enhanced or less-suppressed VOR responses, while higher depressive symptom scores may be associated with reduced reflex responsiveness. Findings will help clarify whether emotional factors confound vestibular test interpretation in clinical practice.