Eun-Ju Jeon; Chae-Hyun Lim; Eun-Jin Son; Chang-Yeong Jeong; Ji Hyung Lim; Hyun Jin Lee

doi:10.21790/rvs.2024.023

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Original Article
Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey: Eun-Ju Jeon¹, Chae-Hyun Lim², Eun-Jin Son³, Chang-Yeong Jeong⁴, Ji Hyung Lim⁵, Hyun Jin Lee¹; Research in Vestibular Science 2024;23(4):156-164.
DOI: https://doi.org/10.21790/rvs.2024.023
Published online: December 15, 2024

¹Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Wing PrimEar Center, Seongnam, Korea

³Department of Otorhinolaryngology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea

⁴Suwon St. Mary’s Otolaryngology Clinic, Suwon, Korea

⁵Boaz Otolaryngology Clinic, Seoul, Korea

Corresponding Author: Eun-Ju Jeon Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Incheon St. Mary’s Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. E-mail: ejmercy@catholic.ac.kr

• Received: November 23, 2024 • Revised: December 9, 2024 • Accepted: December 9, 2024

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

Objectives
This study aims to evaluate the relationship between subjective dizziness disability, as assessed by the Dizziness Handicap Inventory (DHI), and objective vestibular function test (VFT) results in patients presenting with dizziness.
Methods
We conducted a retrospective review of 177 patients who completed the DHI, vertigo visual analog scale, and disability scale at their initial visit. Objective VFTs included videonystagmography with caloric testing, cervical vestibular evoked myogenic potential (cVEMP), and the sensory organization test (SOT). Statistical analyses were conducted to assess correlations and differences in DHI scores based on VFT results and clinical characteristics.
Results
The DHI scores indicated a higher perceived dizziness handicap among female patients compared to males (p=0.012). Chronic dizziness was associated with elevated DHI scores in specific items (DHI-2, DHI-12, and DHI-21; p<0.05). Patients with abnormal caloric responses exhibited higher scores in several DHI items and subscales (DHI-4, DHI-12, DHI-14, DHI-17, DHI-19, DHI-23, physical, emotional, and functional; p<0.05). No significant differences were found in cVEMP results. Only one SOT condition (equilibrium score 5) showed a statistically significant but weak association with DHI scores (r=–0.151, p=0.045).
Conclusions
There were limited correlations between objective vestibular test outcomes and subjective dizziness disability. These findings underscore the multidimensional nature of dizziness and the importance of integrating subjective and objective measures for a comprehensive clinical assessment.
Keywords: Vestibular function tests; Disability evaluation; Vestibular diseases

INTRODUCTION

Dizziness, characterized by symptoms such as vertigo, lightheadedness, disequilibrium, and unsteadiness, presents a common yet complex challenge in clinical practice. It significantly impairs quality of life by affecting patients’ ability to perform daily activities and participate in social engagements. Dizziness can arise from various etiologies, including central and peripheral vestibular disorders, cardiovascular and gastrointestinal diseases, visual impairments, and psychiatric conditions. The nature, duration, frequency, and triggers of dizziness are the most important factors in the diagnosis of dizziness, as they indicate the type, severity, and stage of the disease. These factors are essential in the diagnostic process, serving as indicators of disease course and aiding in differential diagnosis.

Dizziness, as a subjective symptom, is often challenging for patients to describe and for clinicians to assess accurately. To address these challenges, various questionnaires have been developed to consistently evaluate dizziness and the extent of disability. Common tools used for this purpose include the Dizziness Handicap Inventory (DHI) [1], vertigo visual analog scale (VVAS) [2], activities-specific balance confidence scale [3], vestibular activities of daily living scale [4], and disability scale (DS) [5].

Vestibular dysfunction is the most common etiology of dizziness, making vestibular function tests (VFTs) integral in assessing these patients. Standard VFTs include the video head impulse test (vHIT), videonystagmography (VNG), rotational chair testing for semicircular canal function, and vestibular evoked myogenic potentials (VEMPs) for otolithic function. Additionally, dynamic posturography evaluates balance and postural stability, offering further insights into patients’ functional capacity. These objective measures offer a comprehensive evaluation of the extent of vestibular impairment in dizzy patients. However, previous research has indicated that while objective vestibular assessments are essential for diagnosing vestibular pathologies, they do not always correlate well with patients’ perceived handicaps [6,7]. Therefore, relying solely on VFTs is insufficient to fully understand a patient’s condition when evaluating dizziness. Subjective questionnaires play a crucial role in dizziness assessment, providing valuable insights into the patient’s perceived handicap and overall impact on their daily life.

The DHI is the most widely used tool for measuring subjective disability from dizziness. It measures self-perceived disabling effects. It is used as an evaluation of the severity of subjective dizziness, therapeutic planning, and outcome assessment. However, its correlation with objective VFT results has been inconsistently reported in the literature. For instance, electronystagmography results and caloric testing have shown no correlations with DHI scores, in the acute phase and long-term follow-up studies [8-10]. Similarly, cervical VEMPs (cVEMP), which assess saccular function, have generally demonstrated weak or no significant correlation with DHI scores [11]. Dynamic posturography, such as the sensory organization test (SOT), has shown variable associations. Mbongo et al. [12] reported no correlations between posturography results and DHI scores. Gill-Body et al. [13] observed weak to moderate correlations between dynamic posturography and DHI scores.

This study aims to investigate the relationship between subjective dizziness disability, assessed using various questionnaires, and objective VFT outcomes. It also evaluates differences in DHI subscale scores based on dizziness characteristics and VFT abnormalities, to provide an understanding of how these factors contribute to patients’ perceived handicap.

METHODS

Ethics Statement

The Institutional Review Board of The Catholic University of Korea, Incheon St. Mary’s Hospital approved this study (No. OC17RISI0001) and waived the requirement for informed consent due to the retrospective nature of the research.

Study Design and Participants

This retrospective chart review included 181 adult patients who presented with dizziness at the Department of Otolaryngology, Incheon St. Mary’s Hospital and Gangnam Severance Hospital between January 2015 and December 2015. Inclusion criteria encompassed adults presenting with dizziness predominantly of peripheral vestibular origin. Patients with clear central vestibular disorders, significant neurological comorbidities, or incomplete data were excluded. However, cases with mixed or central etiologies identified retrospectively were included. Benign paroxysmal positional vertigo (BPPV) was diagnosed based on characteristic nystagmus observed during positional tests, such as the Dix-Hallpike maneuver or supine roll test. Ménière’s disease was diagnosed according to the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) criteria, including episodic vertigo lasting 20 minutes to 12 hours, low- to mid-frequency sensorineural hearing loss, and fluctuating aural symptoms (e.g., tinnitus, fullness). Vestibular migraine was diagnosed using the Bárány Society diagnostic criteria, which require a history of migraine, at least five episodes of vestibular symptoms lasting 5 minutes to 72 hours, and migraine-associated features (e.g., photophobia, phonophobia) during at least 50% of episodes.

Patients were asked to complete questionnaires assessing subjective dizziness, including the DHI, VVAS, and DS during their initial visits. Patients who completed the questionnaires were included in the analysis. Only patients who completed these questionnaires were included in the analysis.

DHI is a 25-item self-administered questionnaire developed to assess the physical, functional, and emotional impacts of dizziness on patients’ daily lives. Each item is scored on a scale of 0 to 4 points: “Yes” (4 points), “Sometimes” (2 points), and “No” (0 points). The total score ranges from 0 to 100, with higher scores indicating greater self-perceived handicap due to dizziness. It is divided into three subscales: functional, emotional, and physical. The functional subscale consists of nine items that evaluate the impact of dizziness on daily activities and participation, such as the extent to which dizziness restricts travel or housework. The emotional subscale composed of nine items, assesses psychological distress caused by dizziness, such as depression or frustration. The physical subscale includes seven items that reflect physical challenges triggered by dizziness, such as increased symptoms with quick head movements. The VVAS is a simple, single-dimensional tool used to measure the severity of dizziness. Patients are asked to rate their dizziness intensity by marking a point on a 10-cm horizontal line, where 0 represents “no dizziness” and 10 indicates “the worst possible dizziness.” The DS categorizes dizziness-related disability into six levels, from negligible symptoms (score 0) to permanent disability (score 5). Scores of 4 or higher indicate a poor prognosis for vestibular rehabilitation.

Vestibular Function Tests

All patients underwent a comprehensive vestibular function assessment, which included the following tests:

(1) VNG: Using the VisualEyes system (Micromedical, Interacoustics), VNG was performed to assess the function of semicircular canals. Caloric tests were performed with bithermal stimulation at 30 °C and 44 °C, with each irrigation lasting 30 seconds. Patients were positioned supine with their heads elevated 30°. Canal paresis (CP) was calculated using Jongkees’ formula, and an interaural difference of ≥25% was considered abnormal.

(2) cVEMP: cVEMP testing was performed using the Navigator-Pro (Bio-logic, Natus Medical Incorporated) to assess saccular function and inferior vestibular nerve integrity. Patients were instructed to maintain a consistent contraction of the sternocleidomastoid muscle while auditory stimuli were delivered via headphones. Stimuli consisted of 500 Hz tone bursts at 90 dB normal hearing level, presented at a rate of 5.1/sec. Responses were recorded, and the P1 and N1 peak latencies and amplitudes were analyzed. An interaural amplitude asymmetry ratio >26% or absent responses on one or both sides was considered abnormal.

(3) SOT: Balance assessment was conducted using the EquiTest System (NeuroCom International Inc.). The SOT evaluates postural stability across six sensory conditions that progressively alter or remove visual or somatosensory cues. Equilibrium scores (ESs) were calculated as a percentage, representing the angular displacement of the center of gravity from the theoretical limit of stability. Composite scores were derived as the weighted average of the ES from all six conditions. Additionally, sensory ratios, including somatosensory, visual, vestibular, and preference ratios, were derived to quantify the reliance on different sensory inputs for balance control.

Statistical Analysis

The collected data included demographic information (age, sex), dizziness characteristics (e.g., chronicity, duration), and test results from the DHI, VVAS, DS, VNG, cVEMP, and SOT. Statistical analyses were conducted using IBM SPSS Statistics ver. 28 (IBM Corp.). Continuous variables were reported as mean±standard deviation, while categorical variables were presented as frequencies and percentages. To examine differences in subjective disability scores (DHI, VVAS, DS) based on categorical variables such as sex and abnormal findings in CP and cVEMP, independent t-tests were utilized. A p-value of <0.05 was considered statistically significant.

Simple linear regression analysis was performed to evaluate the relationships between continuous variables (e.g., age, dizziness duration, ESs [ES1–ES6] from the SOT) and DHI scores. For analyses involving a single predictor variable, the regression results (R and p-values) are mathematically equivalent to Pearson correlation analysis. Correlation coefficients (r) and p-values were reported to interpret the strength and significance of these relationships. Significance was defined as p<0.05. The strength of correlations was categorized as follows: r<0.25, weak; 0.26–0.50, fair; 0.51–0.75, moderate; and ≥0.76, strong.

RESULTS

The mean age of the subjects was 51.3±15.0 years, including 61 male and 116 female patients. The average duration of dizziness symptoms among the subjects was 489.1±885.8 days, with a wide range from 0 days to 15 years. Among the etiologies of dizziness in the study population, BPPV was the most common, affecting 68 patients, followed by Ménière’s disease (32 cases) and vestibular migraine (24 cases). Table 1 summarizes the demographic and clinical characteristics of acute and chronic dizziness groups. There were no significant differences in age (52.0±15.7 years for chronic vs. 50.7±14.4 years for acute, p=0.571) or sex distribution (25 males and 61 females for chronic vs. 36 males and 55 females for acute, p=0.125). Comorbidities such as hypertension and diabetes were more prevalent in the chronic group, though not statistically significant. Diagnoses associated with chronic group included chronic otitis media (85.7%), vestibular migraine (70.8%), cardiovascular disease (66.7%), and Ménière’s disease (62.5%), whereas acute group was predominantly associated with vestibular schwannoma (100%), vestibular neuritis (83.3%), peripheral vestibular hypofunction (64.3%), and BPPV (61.8%).

The tendency for higher DHI with increasing age appeared, but it was not statistically significant. Analysis showed a very weak positive correlation between age and DHI scores (r=0.116, p=0.110) and a very weak negative correlation between dizziness duration and DHI scores (r=–0.113, p=0.133). These indicate that there is no meaningful association between the age or duration of dizziness symptoms and DHI scores. The mean DHI score for females was significantly higher than males (31.7±25.6 vs. 22.3±23.3, p=0.012), indicating that females reported a higher perceived dizziness handicap than males.

Based on a disease duration criterion of 3 months, dizziness was classified into acute and chronic categories. Out of a total of 181 patients, 94 were classified as having acute dizziness, while 87 were classified as having chronic dizziness. To assess whether dizziness at acute and chronic stages impacts the degree of disability perceived by patients, we analyzed DHI scores across these stages. The acute group included 93 patients, while the chronic group consisted of 84 patients. In the comparison of DHI scores between acute and chronic dizziness groups, certain DHI subscale scores were significantly higher in the chronic group. Specifically, items DHI-2 (p=0.006), DHI-12 (p=0.018), and DHI-21 (p=0.012) demonstrated statistically significant increases in the chronic group. DHI-2 (“Because of your problem, do you feel frustrated?”) and DHI-21 (“Because of your problem, do you feel handicapped?”) are items related to emotional factors, indicating that patients with prolonged dizziness experience greater emotional challenges, including frustration and a sense of handicap. Meanwhile, DHI-12 (“Because of your problem, do you avoid heights?”) reflects functional limitations, suggesting that an extended duration of dizziness may impact patients’ functional performance by increasing activity restrictions. These results illustrate that a longer duration of dizziness is associated with heightened emotional and functional impairments. No significant difference was found in the VVAS (p=0.250) or DS (p=0.409) scores between the two groups (Table 2).

Among the patients, 110 had normal caloric test results (CP <25%), while 66 showed abnormal results (CP ≥25%). When comparing DHI scores between the normal and abnormal CP groups, several DHI items scored higher in the abnormal CP group. Patients with abnormal CP (CP ≥25%) showed significantly higher scores in several DHI items compared to those with normal CP (CP <25%). Specifically, scores were significantly elevated in DHI-4 (“Does walking down the aisle of a supermarket increase your problems?”; p=0.001), DHI-17 (“Does walking down the sidewalk increase your problem?”; p=0.002), and DHI-19 (“Is it difficult for you to walk around your house in the dark?”; p=0.009) highlighting the increased physical discomfort and difficulty in navigating dynamic environments that these patients experience. Additionally, DHI-12 (“Because of your problem, do you avoid heights?”; p=0.037) and DHI-14 (“Is it difficult for you to do strenuous housework?”; p=0.015) indicate a greater tendency among patients with abnormal CP to limit physical activities and avoid challenging environments. Higher scores in DHI-23 (“Because of your problem, do you feel depressed?”; p=0.024) further suggest that these patients experience emotional impacts. Across all DHI subscales (DHI-P, DHI-E, DHI-F) and the DHI-total score, patients with abnormal CP reported significantly higher disability levels (p<0.05 for all). However, no significant differences were observed in VVAS (p=0.784) or DS (p=0.796) scores between the two groups, indicating that the DHI may be more sensitive to capturing the specific physical and emotional challenges associated with abnormal CP (Table 3).

Comparison of questionnaire scores between groups with and without cVEMP abnormalities revealed no statistically significant differences across most items, except for the VVAS, which showed a significant increase in the abnormal group (p=0.033).

The relationship between ESs (ES1–ES6) and DHI scores revealed that among the six conditions, only ES5 demonstrated a weak but statistically significant correlation with DHI scores (r=–0.151, p=0.045). The other conditions (ES1, ES2, ES3, ES4, and ES6) did not show significant associations (Table 4).

DISCUSSION

This study aimed to evaluate the association between subjective dizziness disability, as measured by the DHI, and objective findings from VFTs in a diverse patient population presenting with dizziness. Our results indicate that while there are some statistically significant associations between specific DHI items and abnormal findings in VFTs, the overall correlation between subjective dizziness handicap and objective test results is modest. These findings underscore the complexity of dizziness as a multidimensional symptom influenced by both physiological and psychological factors.

The DHI scores were significantly higher in female patients, consistent with previous research reported that female patients reported larger DHI scores than male [14,15]. This could be attributed to sex-based differences in symptom perception, reporting behaviors, or potentially underlying biological factors.

In this study, chronic patients demonstrated a higher prevalence of comorbidities such as hypertension and diabetes mellitus. Additionally, the distribution of specific diagnoses differs between groups, with conditions like vestibular migraine (70.8%) and Ménière’s disease (62.5%) more prevalent in chronic dizziness, while BPPV (61.8%) and vestibular neuritis (83.3%) were more frequent in the acute group. These findings suggest that the chronic group represents a more heterogeneous population with prolonged symptom duration and a higher prevalence of complex vestibular and systemic conditions. The elevated DHI scores observed in this group likely reflect the compounded effects of prolonged dizziness, psychological stress, and potential multisystem dysfunction. Future studies should investigate the interplay between these factors to better understand the mechanisms underlying chronic dizziness disability.

Patients with chronic dizziness reported greater perceived handicap on specific DHI items, such as DHI-2, DHI-12, and DHI-21, compared to those with acute dizziness. This observation aligns with a prior study that patients with dizziness of more than 3 months experience greater disability than patients with dizziness of less than 1 month [14]. This suggests that prolonged dizziness symptoms may exacerbate functional and emotional impairments, highlighting the importance of early intervention to mitigate long-term disability.

In terms of objective test findings, patients with abnormal caloric test results demonstrated significantly higher scores in specific DHI items (DHI-4, DHI-12, DHI-14, and DHI-17) and across all subscales (physical, emotional, functional), as well as in the total DHI score (Table 3). These findings suggest that CP has a multidimensional impact on dizziness-related disability, affecting both physical functionality and emotional well-being. Our findings contrast with previous studies, such as Mandalà and Nuti [9] and Kim et al. [8], which reported no significant correlation between caloric test results and DHI scores. Mandalà and Nuti [9] examined patients 4 to 6 years post-vestibular neuritis, with a mean total DHI score of 12.51±15.13, indicating that most had minimal dizziness and likely achieved vestibular compensation. This relatively mild levels of dizziness reported in this population, as evidenced by the DHI scores may have reduced the sensitivity to detect correlations with CP severity. Similarly, Kim et al. [8] studied patients in the acute phase of vestibular neuritis, where severe vertigo and emotional distress overshadow the specific influence of CP on perceived disability. In contrast, our study included patients across various disease stages, which may explain the significant association observed between abnormal CP and higher DHI scores, particularly in functional and emotional domains.

There was no significant correlation between cVEMP abnormalities and DHI scores, suggesting that saccular dysfunction alone may not directly correlate with patients’ subjective perception of dizziness handicap. Our findings align with those of McCaslin et al. [11], who reported no significant differences in DHI scores among groups with isolated cVEMP abnormalities, caloric test abnormalities, or combined abnormalities. Our study suggests that subjective dizziness disability may result more from the combined effects of vestibular deficits rather than isolated otolithic dysfunction. Further research incorporating broader otolith assessments may clarify these relationships.

The relationship between posturography and DHI has been inconsistently reported in the literature. Robertson and Ireland [16] reported weak associations between posturography results and DHI scores. Gill-Body et al. [13] found weak to moderate correlations between dynamic posturography and DHI scores, with balance impairments explaining 13% of DHI variance in unilateral vestibular hypofunction (UVH) and 78% in bilateral vestibular hypofunction. Similarly, Mbongo et al. [12] reported no significant correlation between DHI scores and dynamic posturography in UVH patients. These findings suggest that the relationship between balanced impairments and subjective dizziness is relatively weak in UVH populations. Vereeck et al. [17] highlighted that dynamic functional tests, such as the dynamic gait index (DGI), show stronger correlations with DHI scores than static balance tests like the single-leg stance or Romberg test. Our analysis of postural stability using the SOT revealed a statistically significant, weak association between DHI scores and ES5. This finding indicates that vestibular-specific conditions like ES5 may better capture the perceived impact of vestibular dysfunction on daily life compared to broader posturography measures and emphasize the limited utility of static posturography in understanding subjective dizziness and highlight the potential value of dynamic functional tests, such as the DGI, for clinical assessments.

In this study, the DHI showed significant differences based on dizziness characteristics and VFT outcomes, while the VVAS and DS did not show any difference. This finding shows the DHI’s ability to assess the physical, functional, and emotional impacts of dizziness, making it more sensitive to variations in chronic cases and significant vestibular dysfunction. Clinically, the DHI is recommended for comprehensive evaluations, particularly in chronic dizziness or for treatment planning, while VVAS and DS are more suitable for quick assessments of dizziness severity and overall disability levels.

We evaluated the relationship between subjective dizziness disability, assessed by DHI, and objective VFT results. While chronic dizziness and abnormal CP were associated with higher DHI scores, no significant correlations were found with cVEMP abnormalities, and only a weak association was observed with the ES5 from the SOT. Our findings highlight that subjective dizziness handicap, measured by DHI, reflects multidimensional factors beyond vestibular dysfunction. Incorporating both subjective and objective measures is essential for a comprehensive assessment of dizziness-related disability. Comprehensive assessments combining subjective and objective measures are essential for understanding dizziness-related disability and optimizing patient management.

This study has several limitations. The retrospective nature of the study may introduce bias, and the cross-sectional design limits the ability to assess changes over time. The heterogeneity of disease conditions, ranging from peripheral vestibular disorders to cardiovascular conditions, may have influenced the results. Additionally, vHIT results were not included in this study, as vHIT equipment was not available during the study period. While vHIT is a critical tool for evaluating high-frequency vestibulo-ocular reflex (VOR) function, its omission limits the ability to fully assess VOR functions. Future studies incorporating vHIT results and focusing on more homogenous patient populations may provide a more comprehensive understanding of the factors influencing subjective dizziness disability.

ARTICLE INFORMATION

Funding/Support

None.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Availability of Data and Materials

The datasets are not publicly available but are available from the corresponding author upon reasonable request.

Authors’ Contributions

Conceptualization, Methodology: EJJ, EJS; Data curation: CHL, CYJ, JHL; Formal analysis: HJL; Project administration: EJJ; Writing–Original Draft: CHL; Writing–Review & Editing: All authors.

All authors read and approved the final manuscript.

Table 1.

Demographic data and etiologies of the patients with dizziness

Variable	Total	Acute	Chronic	p-value
Age (yr)	51.3±15.0	50.7±14.4	52.0±15.7	0.571
Sex, male:female	61:116	36:55	25:61	0.125
Duration of dizziness (day)	489.1±885.8	21.2±20.9	950.8±1,055.1	<0.001
Hypertension	41 (23.2)	16 (17.6)	25 (29.1)	0.103
Diabetes mellitus	15 (8.5)	5 (5.5)	10 (11.6)	0.232
Diagnosis
BPPV	68	42 (61.8)	26 (38.2)
Ménière’s disease	32	12 (37.5)	20 (62.5)
Vestibular migraine	24	7 (29.2)	17 (70.8)
PVH	14	9 (64.3)	5 (35.7)
Cardiovascular disease	12	4 (33.3)	8 (66.7)
Chronic otitis media	7	1 (14.3)	6 (85.7)
Vestibular neuritis	6	5 (83.3)	1 (16.7)
Vestibular schwannoma	5	5 (100)	0 (0)
Cervicogenic	3	2 (66.7)	1 (33.3)
Central lesion	2	1 (50.0)	1 (50.0)
Temporal bone fracture	2	1 (50.0)	1 (50.0)
Drug	1	1 (100)	0 (0)
Post-traumatic dizziness	1	1 (100)	0 (0)
Total	91	86	177

Values are presented as mean±standard deviation, number only, or number (%).

BPPV, benign paroxysmal positional vertigo; PVH, peripheral vestibular hypofunction.

Table 2.

Comparison of DHI scores between acute and chronic dizziness patients

Questionnaire	Acute	Chronic	p-value
Visual analog scale	6.1±2.7	6.6±2.6	0.250
Disability scale	2.2±1.1	2.0±1.3	0.409
DHI-1	1.2±1.3	1.6±1.3	0.104
DHI-2	1.0±1.3	1.6±1.6	0.006^*
DHI-3	1.2±1.5	1.4±1.62	0.451
DHI-4	0.8±1.2	0.9±1.5	0.457
DHI-5	1.2±1.3	1.6±1.5	0.066
DHI-6	1.2±1.5	1.1±1.5	0.714
DHI-7	0.8±1.3	1.2±1.5	0.078
DHI-8	1.3±1.5	1.5±1.7	0.339
DHI-9	1.0±1.4	1.3±1.6	0.159
DHI-10	0.8±1.2	1.1±1.3	0.087
DHI-11	1.8±1.5	2.2±1.6	0.084
DHI-12	0.9±1.4	1.5±1.6	0.018^*
DHI-13	1.3±1.4	1.3±1.5	0.701
DHI-14	1.2±1.5	1.4±1.6	0.329
DHI-15	1.3±1.4	0.6±1.2	0.563
DHI-16	1.0±1.4	1.1±1.6	0.378
DHI-17	1.3±1.4	1.0±1.5	0.951
DHI-18	1.4±1.4	1.6±1.5	0.918
DHI-19	1.3±1.4	1.0±1.5	0.402
DHI-20	0.8±1.3	1.0±1.4	0.581
DHI-21	1.3±1.4	1.4±1.6	0.012^*
DHI-22	0.9±1.2	1.1±1.6	0.438
DHI-23	1.3±1.5	1.6±1.6	0.152
DHI-24	1.6±1.4	1.7±1.6	0.579
DHI-25	1.4±1.4	1.7±1.6	0.188
DHI-physical	8.7±6.6	10.2±7.5	0.157
DHI-emotional	8.4±7.5	11.1±10.6	0.051
DHI-functional	9.9±8.8	12.1±10.8	0.149
DHI-total	27.0±20.9	33.4±27.5	0.087

Values are presented as mean±standard deviation.

DHI, Dizziness Handicap Inventory.

^*p<0.05.

Table 3.

Comparison of DHI scores between patients with normal and abnormal CP

Questionnaire	CP<25%	CP≥25%	p-value
Visual analog scale	6.3±2.6	6.4±2.7	0.784
Disability scale	2.1±1.1	2.0±1.2	0.796
DHI-1	1.3±1.3	1.6±1.4	0.234
DHI-2	1.2±1.4	1.5±1.6	0.339
DHI-3	1.1±1.4	1.5±1.7	0.128
DHI-4	0.5±1.0	1.3±1.6	0.001^*
DHI-5	1.3±1.4	1.6±1.5	0.156
DHI-6	1.1±1.5	1.4±1.6	0.147
DHI-7	0.9±1.2	1.3±1.6	0.056
DHI-8	1.2±1.5	1.6±1.7	0.149
DHI-9	0.9±1.4	1.3±1.6	0.107
DHI-10	0.9±1.2	1.1±1.4	0.243
DHI-11	1.9±1.5	2.1±1.6	0.437
DHI-12	1.0±1.4	1.5±1.7	0.037^*
DHI-13	1.2±1.5	1.4±1.5	0.583
DHI-14	1.1±1.4	1.7±1.7	0.015^*
DHI-15	0.4±0.9	0.7±1.3	0.050
DHI-16	0.9±1.4	1.3±1.6	0.087
DHI-17	0.7±1.2	1.5±1.6	0.002^*
DHI-18	1.3±1.3	1.7±1.6	0.102
DHI-19	0.7±1.2	1.3±1.6	0.009^*
DHI-20	0.7±1.2	1.2±1.5	0.070
DHI-21	1.0±1.5	1.2±1.5	0.618
DHI-22	0.8±1.3	1.2±1.5	0.051
DHI-23	1.2±1.4	1.7±1.6	0.024^*
DHI-24	1.5±1.4	1.9±1.6	0.102
DHI-25	1.4±1.4	1.8±1.6	0.077
DHI-physical	8.3±6.3	11.1±7.9	0.016^*
DHI-emotional	8.5±7.9	11.6±10.8	0.045^*
DHI-functional	9.4±8.2	13.5±11.7	0.016^*
DHI-total	26.2±20.6	36.1±28.9	0.017^*

Values are presented as mean±standard deviation.

DHI, Dizziness Handicap Inventory; CP, canal paresis.

^*p<0.05.

Table 4.

Correlation analysis of ESs of sensory organization test and Dizziness Handicap Inventory scores

ES	Correlation coefficient (r)	p-value
ES1	–0.063	0.405
ES2	–0.087	0.252
ES3	–0.100	0.184
ES4	–0.084	0.268
ES5	–0.151	0.045^*
ES6	0.034	0.654

ES, equilibrium score.

^*p<0.05.

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Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey

Res Vestib Sci. 2024;23(4):156-164. Published online December 15, 2024

DOI: https://doi.org/10.21790/rvs.2024.023

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Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey

Variable	Total	Acute	Chronic	p-value
Age (yr)	51.3±15.0	50.7±14.4	52.0±15.7	0.571
Sex, male:female	61:116	36:55	25:61	0.125
Duration of dizziness (day)	489.1±885.8	21.2±20.9	950.8±1,055.1	<0.001
Hypertension	41 (23.2)	16 (17.6)	25 (29.1)	0.103
Diabetes mellitus	15 (8.5)	5 (5.5)	10 (11.6)	0.232
Diagnosis
BPPV	68	42 (61.8)	26 (38.2)
Ménière’s disease	32	12 (37.5)	20 (62.5)
Vestibular migraine	24	7 (29.2)	17 (70.8)
PVH	14	9 (64.3)	5 (35.7)
Cardiovascular disease	12	4 (33.3)	8 (66.7)
Chronic otitis media	7	1 (14.3)	6 (85.7)
Vestibular neuritis	6	5 (83.3)	1 (16.7)
Vestibular schwannoma	5	5 (100)	0 (0)
Cervicogenic	3	2 (66.7)	1 (33.3)
Central lesion	2	1 (50.0)	1 (50.0)
Temporal bone fracture	2	1 (50.0)	1 (50.0)
Drug	1	1 (100)	0 (0)
Post-traumatic dizziness	1	1 (100)	0 (0)
Total	91	86	177

Questionnaire	Acute	Chronic	p-value
Visual analog scale	6.1±2.7	6.6±2.6	0.250
Disability scale	2.2±1.1	2.0±1.3	0.409
DHI-1	1.2±1.3	1.6±1.3	0.104
DHI-2	1.0±1.3	1.6±1.6	0.006^*
DHI-3	1.2±1.5	1.4±1.62	0.451
DHI-4	0.8±1.2	0.9±1.5	0.457
DHI-5	1.2±1.3	1.6±1.5	0.066
DHI-6	1.2±1.5	1.1±1.5	0.714
DHI-7	0.8±1.3	1.2±1.5	0.078
DHI-8	1.3±1.5	1.5±1.7	0.339
DHI-9	1.0±1.4	1.3±1.6	0.159
DHI-10	0.8±1.2	1.1±1.3	0.087
DHI-11	1.8±1.5	2.2±1.6	0.084
DHI-12	0.9±1.4	1.5±1.6	0.018^*
DHI-13	1.3±1.4	1.3±1.5	0.701
DHI-14	1.2±1.5	1.4±1.6	0.329
DHI-15	1.3±1.4	0.6±1.2	0.563
DHI-16	1.0±1.4	1.1±1.6	0.378
DHI-17	1.3±1.4	1.0±1.5	0.951
DHI-18	1.4±1.4	1.6±1.5	0.918
DHI-19	1.3±1.4	1.0±1.5	0.402
DHI-20	0.8±1.3	1.0±1.4	0.581
DHI-21	1.3±1.4	1.4±1.6	0.012^*
DHI-22	0.9±1.2	1.1±1.6	0.438
DHI-23	1.3±1.5	1.6±1.6	0.152
DHI-24	1.6±1.4	1.7±1.6	0.579
DHI-25	1.4±1.4	1.7±1.6	0.188
DHI-physical	8.7±6.6	10.2±7.5	0.157
DHI-emotional	8.4±7.5	11.1±10.6	0.051
DHI-functional	9.9±8.8	12.1±10.8	0.149
DHI-total	27.0±20.9	33.4±27.5	0.087

Questionnaire	CP<25%	CP≥25%	p-value
Visual analog scale	6.3±2.6	6.4±2.7	0.784
Disability scale	2.1±1.1	2.0±1.2	0.796
DHI-1	1.3±1.3	1.6±1.4	0.234
DHI-2	1.2±1.4	1.5±1.6	0.339
DHI-3	1.1±1.4	1.5±1.7	0.128
DHI-4	0.5±1.0	1.3±1.6	0.001^*
DHI-5	1.3±1.4	1.6±1.5	0.156
DHI-6	1.1±1.5	1.4±1.6	0.147
DHI-7	0.9±1.2	1.3±1.6	0.056
DHI-8	1.2±1.5	1.6±1.7	0.149
DHI-9	0.9±1.4	1.3±1.6	0.107
DHI-10	0.9±1.2	1.1±1.4	0.243
DHI-11	1.9±1.5	2.1±1.6	0.437
DHI-12	1.0±1.4	1.5±1.7	0.037^*
DHI-13	1.2±1.5	1.4±1.5	0.583
DHI-14	1.1±1.4	1.7±1.7	0.015^*
DHI-15	0.4±0.9	0.7±1.3	0.050
DHI-16	0.9±1.4	1.3±1.6	0.087
DHI-17	0.7±1.2	1.5±1.6	0.002^*
DHI-18	1.3±1.3	1.7±1.6	0.102
DHI-19	0.7±1.2	1.3±1.6	0.009^*
DHI-20	0.7±1.2	1.2±1.5	0.070
DHI-21	1.0±1.5	1.2±1.5	0.618
DHI-22	0.8±1.3	1.2±1.5	0.051
DHI-23	1.2±1.4	1.7±1.6	0.024^*
DHI-24	1.5±1.4	1.9±1.6	0.102
DHI-25	1.4±1.4	1.8±1.6	0.077
DHI-physical	8.3±6.3	11.1±7.9	0.016^*
DHI-emotional	8.5±7.9	11.6±10.8	0.045^*
DHI-functional	9.4±8.2	13.5±11.7	0.016^*
DHI-total	26.2±20.6	36.1±28.9	0.017^*

ES	Correlation coefficient (r)	p-value
ES1	–0.063	0.405
ES2	–0.087	0.252
ES3	–0.100	0.184
ES4	–0.084	0.268
ES5	–0.151	0.045^*
ES6	0.034	0.654

Table 1. Demographic data and etiologies of the patients with dizziness

Values are presented as mean±standard deviation, number only, or number (%).

BPPV, benign paroxysmal positional vertigo; PVH, peripheral vestibular hypofunction.

Table 2. Comparison of DHI scores between acute and chronic dizziness patients

Values are presented as mean±standard deviation.

DHI, Dizziness Handicap Inventory.

p<0.05.

Table 3. Comparison of DHI scores between patients with normal and abnormal CP

Values are presented as mean±standard deviation.

DHI, Dizziness Handicap Inventory; CP, canal paresis.

p<0.05.

Table 4. Correlation analysis of ESs of sensory organization test and Dizziness Handicap Inventory scores