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Objectives: Symptomatic vestibulopathy impairs patients' lives. However, few studies have explored the lives of patients with compensated or asymptomatic vestibulopathy. This study investigated the quality of life (QOL), psychological health, and physical function of patients with vestibulopathy., Materials and Methods: Using the eighth Korea National Health and Nutrition Examination Survey database, we included individuals with data on demographic factors, diabetes, hypertension, dizziness experiences, pure-tone audiometry, video head impulse test (vHIT), Health-related Quality of Life Instrument with 8 Items, General Anxiety Disorder 7-item scale, stress, and walking and sitting times. Participants were classified into the following groups: an uncompensated group with abnormal vHIT result and chronic dizziness, a compensated group with abnormal vHIT result and a history of dizziness, an asymptomatic group with abnormal vHIT result and no history of dizziness, and a normal group without abnormal vHIT result or a history of dizziness., Results: Uncompensated vestibulopathy was more common in older individuals and women. The uncompensated group showed impairments in climbing stairs (P < 0.001), pain (P < 0.001), vitality (P = 0.001), working (P < 0.001), depression (P < 0.001), sleep (P = 0.001), happiness (P = 0.002), anxiety (P = 0.006), and stress (P = 0.003). The compensated group showed deficits in pain (P < 0.001), work (P = 0.006), sleep (P = 0.001), and happiness (P = 0.001). The asymptomatic group had no deficits in QOL, psychological health, or physical function. These tendencies were similar after controlling for age and gender., Conclusion: Vestibulopathy with a history of dizziness has a long-lasting impact on QOL and emotional status, even after compensation. Uncompensated vestibulopathy has a significant effect on QOL and mental health. Notably, though, the compensated group also showed a reduction in QOL. Appropriate interventions for each category of patients should be provided based on their impaired functions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

Background/aims: Vestibular rehabilitation has an important role in the reduction of symptoms and in the recovery of patients in peripheral vestibular pathologies. Objective and subjective vestibular assessment tools are needed to assess vestibular rehabilitation effectiveness. The aims of the study were to develop the Turkish version of the internationally used Vestibular Rehabilitation Benefit Questionnaire (VRBQ) measure and to demonstrate the reliability and validity properties of the Turkish version in patients with peripheral vestibular hypofunction (PVH)., Materials and Methods: 110 patients with unilateral PVH were included. For the analysis of test-retest reliability, Turkish version of VRBQ developed by translation-back translation method was applied to patients on the day of admission and the day after admission. To assess validity, patients were also evaluated with the VRBQ, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), Vertigo Dizziness Imbalance (VDI) Questionnaire., Results: The VRBQ showed moderate to excellent internal consistency in total score and subscales scores (VRBQ-total Cronbach’s α = 0.91; dizziness α = 0.81; anxiety α = 0.68; motion-provoked dizziness α = 0.89; aypmtoms α = 0.88; health-related quality of life α = 0.87). In the test-retest reliability of VRBQ-total score was excellent (ICC = 0.94). The dizziness, the anxiety, the motion-provoked dizziness, symptoms and the health-related quality of life domains’ ICC were found respectively 0.90, 0.89, 0.84, 0.90, and 0.92. The construct validity of the VRBQ was determined. The VRBQ total was correlated with all parameters (r: 0.308 to –0.699, P < 0.05). The highest positive correlation was found between VRBQ total and DHI-functional (r: 0.680). The highest negative correlation was found between VRBQ total and VDI-total (r: –0.699)., Conclusion: The results suggest that the Turkish version of the VRBQ is reliable and valid for evaluating the vestibular rehabilitation results., Competing Interests: This article has no conflict of interest and funding sources., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: Secondary analysis, testing the effect on change in health-related quality of life of group-based vestibular rehabilitation in patients with mild-moderate traumatic brain injury, dizziness and -balance problems., Design: A single-blind randomized controlled trial., Subjects: A total of 65 patients aged 16-60 years with a Rivermead Post-concussion Symptoms Questionnaire dizziness score ≥2, and Dizziness Handicap Inventory score >15 points. Data collection was performed at baseline 3.5 (standard deviation (SD) 2.1) months post-injury, end of intervention, and 4.4 (SD 1.0) months after baseline., Methods: Quality of Life after Brain Injury was the main outcome. Independent variables were demographic and injury variables, Hospital Anxiety and Depression Scale, changes on the Rivermead Post-concussion Symptoms Questionnaire (RPQ3 physical and RPQ13 psychological/cognitive), and Vertigo Symptom Scale-Short Form., Results: Mean age of participants was 39.4 years (SD 13.0); 70.3% women. Predictors of change in the Quality of Life after Brain Injury were receiving the vestibular rehabilitation (p=0.049), baseline psychological distress (p=0.020), and change in RPQ3 physical (p=0.047) and RPQ13 psychological/cognitive (p=0.047). Adjusted R2 was 0.399, F=6.13, p<0.001., Conclusion: There was an effect in favour of the intervention group in improvement in health-related quality of life. Changes on the Rivermead Post-concussion Symptoms Questionnaire were also associated with change on the Quality of Life after Brain Injury.

Objectives: To prospectively investigate the recovery of athlete-reported symptoms and the condition-specific health-related quality of life (HRQoL) following sport-related concussion., Design: Prospective matched-cohort study., Methods: We recruited amateur athletes who were diagnosed with sport-related concussion by emergency department physicians. Study participants were assessed at 3 time points following sport-related concussion. At each assessment, participants completed 5 condition-specific HRQoL patient-reported outcome measures to evaluate participants' perceptions of the effects of specific concussion-related symptoms on their HRQoL. We performed log-linear analyses to assess the proportion of concussed participants with clinically impaired condition-specific HRQoL compared with the proportion of participants in the control group with clinically impaired condition-specific HRQoL., Results: Fifty participants with sport-related concussion and 50 control participants matched by sex, age, and activity completed the study. Upon return to sporting activity, there was a significantly greater proportion of participants in the concussion group who perceived that headache, neck pain, and dizziness had an adverse effect on their HRQoL compared with the control group. Two weeks after return to sporting activity, there was still a significantly greater proportion of participants in the concussion group who perceived that headache ( χ 2 1 = 9.0; odds ratio [OR] = 4.4; 95% confidence interval [CI]: 1.5, 15.2; P = .003) and dizziness ( χ 2 1 = 9.5; OR = 13.5; 95% CI: 1.8, 604.9; P = .006) had an adverse effect on their HRQoL compared with the proportion of clinically impaired participants in the control group., Conclusion: Of concussed participants, 1 in 4 perceived that headache and dizziness had adverse effects on their HRQoL after returning to sporting activity following sport-related concussion compared with nonconcussed, control participants. J Orthop Sports Phys Ther 2020;50(12):692-701. doi:10.2519/jospt.2020.9485 .

Background: An important question influencing therapy for dizziness is whether the strengths of the relationships of emotional and functional aspects of dizziness to 1) anxiety and other mental states, 2) perceived state of health (SoH) and quality of life (QoL) are different in patients with and without normal balance control. We attempted to answer this question by examining these dimensions' regression strengths with Dizziness Handicap Inventory (DHI) scores., Methods: We divided 40 patients receiving group cognitive behavioural therapy (CBT) and vestibular rehabilitation for dizziness, into 2 groups: dizziness only (DO) and normal balance control; dizziness and a quantified balance deficit (QBD). Group-wise, we first performed stepwise multivariate regression analysis relating total DHI scores with Brief Symptom Inventory (BSI) sub-scores obtained pre- and post-therapy. Then, regression analysis was expanded to include SoH, QoL, and balance scores. Finally, we performed regressions with DHI sub-scores., Results: In both groups, the BSI phobic anxiety state score was selected first in the multivariate regression analysis. In the DO group, obsessiveness/compulsiveness was also selected. The correlation coefficient, R, was 0.74 and 0.55 for the DO and QBD groups, respectively. When QoL and SoH scores were included, R values increased to 0.86 and 0.74, explaining in total 74, and 55% of the DHI variance for DO and QBD groups, respectively. Correlations with balance scores were not significant (R ≤ 0.21). The psychometric scores selected showed the strongest correlations with emotional DHI sub-scores, and perceived QoL and SoH scores with functional DHI sub-scores., Conclusions: Our findings suggest that reducing phobic anxiety and obsessiveness/compulsiveness during CBT may improve emotional aspects of dizziness and targeting perceived SoH and QoL may improve functional aspects of dizziness for those with and without normal balance control.

Purpose: Benign paroxysmal positional vertigo (BPPV) is diagnosed and divided into subtypes based on positioning vertigo and nystagmus. Whether these subtypes entail any significant differences in patient-reported symptoms; is yet not known. Such differences may have clinical and therapeutic consequences. Our aim was to assess dizziness handicap and clinical characteristics of posterior and lateral canal BPPV., Methods: This prospective observational multicentre study analysed consecutive patients with BPPV, confirmed by standardized procedures including videonystagmography under diagnostic manoeuvres in a biaxial rotational chair. Patients were screened for other neurological and otological disorders., Outcomes: Dizziness handicap inventory (DHI), posterior vs. lateral canal involvement., Factors: age, gender, positional nystagmus intensity (maximum slow-phase velocity), symptom duration, 25-hydroxyvitamin D-level and traumatic aetiology., Results: 132 patients aged 27-90 (mean 57, SD 13) years were included. Higher DHI scores were associated with lateral canal BPPV [95% CI (1.59-13.95), p = 0.01] and female gender [95% CI (0.74-15.52), p = 0.03]. Lateral canal BPPV was associated with longer symptom duration [OR 1.10, CI (1.03-1.17), p = 0.01] and lower 25-hydroxyvitamin D-levels [OR 0.80, CI (0.67-0.95), p = 0.03]. There was no correlation between DHI scores and nystagmus intensity., Conclusions: This study suggests that patients with lateral canal BPPV have increased patient-perceived disability, lower vitamin D-levels and longer duration of symptoms. This subtype might therefore require closer follow-up. Patient-perceived disability is not related to positional nystagmus intensity.

Objectives: To (a) explore the experiences of persistent postural-perceptual dizziness (PPPD), formerly chronic subjective dizziness on the personal, work and social lives of working-age adults; (b) enhance current understandings of the condition and its impact on the lives of working-age adults and (c) highlight points for consideration and importance to clinical practice., Methods: This qualitative exploratory study drew on interpretive descriptive methodology. Working-age adults (n=8) diagnosed with PPPD were recruited from a single New Zealand community-based specialist clinic. Data from interviews (n=8) and postinterview reflections (n=2) were analysed using thematic analysis., Results: Three themes were constructed: (1) It sounds like I'm crazy-referring to the lack of medical, social and self-validation associated with PPPD; (2) I'm a shadow of my former self-representing the impact of the condition on sense of self and life trajectory and (3) How will I survive?- highlighting individual coping processes., Conclusion: This study contributed to the existing body of knowledge by highlighting the complexity and fluidity of experiencing PPPD. It also drew attention to the tension between the acute illness framework that forms the basis of many therapeutic interactions and the enduring psychosocial support needs of the person experiencing PPPD. The findings highlighted that contextual factors need to be taken into account and that a person-centred and biopsychosocial approach, rather than a condition-specific biomedical approach, is needed for care to be perceived as meaningful and satisfactory., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Persistent postural-perceptual dizziness (PPPD) is one of the most common causes of chronic vestibular disorders, with a substantial portion of the affected patients showing no significant improvement to standard therapies (i.e., pharmacotherapy, behavioral psychotherapy). Patients with PPPD have been shown to have a significant comorbidity with anxiety disorders and depression. Further, these patients show an activation of the autonomic nervous system resulting in symptoms such as nausea, increase of heart rate, and sweating. Based on the comorbidities and the activation of the autonomic nervous system, we addressed the question whether non-invasive vagus nerve stimulation (nVNS) might be a treatment option for these patients. In this prospective study we, therefore, applied nVNS to patients with treatment-refractory (to the standard therapy) PPPD. The stimulation protocol was similar to previous studies in patients with cluster headache and consisted of stimulations during exacerbations or acute attacks of vertigo, but also with regular stimulations in the morning and evening as prophylactic treatment. Results showed that non-invasive vagus nerve stimulation significantly improved quality of life, as measured by the EQ-5D-3L (p = 0.04), and depression, as measured by the HADS-D (p = 0.002), in the nVNS group, but not in the age- and sex-matched group with standard of care (SOC) treatment. Moreover, in the pooled analysis (additional 4 weeks of stimulation also in the SOC-group), less severe vertigo attacks/exacerbations (p = 0.04), a decrease in total postural sway path as measured by posturography (p = 0.02), as well as tendentious less anxiety (p = 0.08), occurred after stimulation. These data imply that short term nVNS is a safe and promising treatment option in patients with otherwise refractory PPPD.

Introduction: Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing., Objective: The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) ., Methods: Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals., Ethics and Dissemination: The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Dizziness is a common medical condition that has been related to falls in the elderly, and it is, therefore, considered a severe social health problem. Particularly in the elderly, the impact of dizziness may be relevant, as it has been linked to several conditions, such as isolation, depression, reduced self autonomy, and self control. The social, functional, and psychological well-being of those affected can be hampered significantly, thus reducing the quality-of-life (QoL) perception. In addition, due to the aging of the population in the developed world, dizziness is becoming a growing public health problem; an optimal management of this condition includes, nowadays, the improvement of rehabilitative programs, as well as the evaluation of QoL status and its management. The aim of this paper is to evaluate the impact of dizziness on the QoL in the elderly, also analyzing the instruments available, nowadays, to evaluate QoL of dizzy patients.

The objective of the present work was to study the influence of the dry extract from the leaves of Ginkgo biloba EGb 761 (used as monotherapy at a dose of 120 mg twice daily during 4 months) on the vestibular function of the patients presenting with cochleovestibular pathology of peripheral and mixed genesis. We present the results obtained by the objective and subjective methods for the evaluation of the vestibular function as well as the neurological and psychoemotional state of the 40 patients that was carried out during the four months of memoplant monotherapy. It is concluded that monotherapy with the use of the dry extract from Ginkgo biloba leaves can be applied for the purpose of improvement of static and dynamic balancing state. Moreover, this memoplant preparation can be used as a means of prophylaxis of recurrent dizziness that in addition reduces the severity of anxiety and depression without producing adverse side effects.

The presence of utricular and saccular dysfunction impairs quality of life (QoL) in patients. The aims of the present study were to examine the effect of repositioning maneuvers on QoL of patients with idiopathic benign paroxysmal positional vertigo (BPPV) and to describe the effect of cervical vestibular-evoked myogenic potential (cVEMP) or ocular VEMP (oVEMP) abnormalities on patient recovery after rehabilitation. Thirty idiopathic BPPV patients with/without otolith dysfunctions (n = 15, each group) were included in this clinical trial study. Otolith dysfunction was determined using oVEMP and cVEMP abnormalities. EcochG and caloric tests were performed to rule out other causes of secondary BPPV. The QoL in groups of patients with idiopathic BPPV was assessed using a Persian version of the dizziness handicap inventory (DHI-P) before and after treatment with Epley's maneuver. Pre-treatment results showed significant handicaps in both groups. DHI-P scores were higher in BPPV patients with otolith dysfunction (total, functional, emotional, physical score: 34.13, 11.20, 7.06, 15.86, respectively) than those in patients without otolith dysfunction (total, functional, emotional, physical score: 25.46, 7.86, 6.13, 11.46, respectively, P < 0.05). After treatment, DHI-P scores decreased in both groups. However, in the otolith dysfunction group, DHI-P scores (total, functional, emotional, physical score: 9.20, 3.33, 1.33, 4.53, respectively) were higher than those in patients without otolith dysfunction (total, functional, emotional, physical score: 4.13, 0.93, 1.06, 2.00, respectively). In BPPV patients with cVEMP or oVEMP abnormalities, QoL is more compromised in comparison with that in BPPV patients without these dysfunctions. Otolith dysfunction enhances the negative effects of BPPV on QoL.

Background: Dizziness or vertigo is associated with both vestibular-balance and psychological factors. A common assessment tool is the Vertigo Symptom Scale (VSS) -short form, which has two subscales: vestibular-balance and autonomic-anxiety. Despite frequent use, the factor structure of the VSS-short form has yet to be confirmed. Here, we clarified the factor structure of the VSS-short form, and assessed the validity and reliability of the Japanese version of this tool., Methods: We conducted a cross-sectional, multicenter, psychometric evaluation of patients with non-central dizziness or vertigo persisting for longer than 1 month. Participants completed the VSS-short form, the Dizziness Handicap Inventory, and the Hospital Anxiety and Depression Scale. They also completed the VSS-short form a second time 1-3 days later. The questionnaire was translated into Japanese and cross-culturally adapted. We conducted a confirmatory factor analysis followed by an exploratory factor analysis. Convergent and discriminant validity, internal consistency, and test-retest reliability were evaluated., Results: The total sample and retest sample consisted of 159 and 79 participants, respectively. Model-fitting for a two-subscale structure in a confirmatory factor analysis was poor. An exploratory factor analysis produced a three-factor structure: long-duration vestibular-balance symptoms, short-duration vestibular-balance symptoms, and autonomic-anxiety symptoms. Regarding convergent and discriminant validity, all hypotheses were clearly supported. We obtained high Cronbach's α coefficients for the total score and subscales, ranging from 0.758 to 0.866. Total score and subscale interclass correlation coefficients for test-retest reliability were acceptable, ranging from 0.867 to 0.897., Conclusions: The VSS-short form has a three-factor structure that was cross-culturally well-matched with previous data from the VSS-long version. Thus, it was suggested that vestibular-balance symptoms can be analyzed separately according to symptom duration, which may reflect pathophysiological factors. The VSS-short form can be used to evaluate vestibular-balance symptoms and autonomic-anxiety symptoms, as well as the duration of vestibular-balance symptoms. Further research using the VSS-short form should be required in other languages and populations.

The present article is focused on the detailed analysis of the history of a patient suffering from combined dizziness including the entire course of the disease, the complicating complex of complaints, and the increasing number of abnormal components of the patient's condition. The specific features of various nosological forms of the disease are described as arising from different clinical entities causing vertigo. The special emphasis is laid on the diagnostic algorithm for the elucidation of these disorders.

Background: Dizziness adversely affects an individual's well-being. However, its impact is not only influenced by its physical manifestations, but also by its subjective importance to the patient. Appropriately assessing the subjective burden of dizziness is difficult. The Pictorial-Representation of Illness- and Self-Measure (PRISM), on which patients illustrate the distance between their 'self' and their illness, has been documented to indicate the perception of suffering in several different illnesses. Our study objectives were (1) to assess how useful the PRISM is in patients with dizziness; and (2) to determine which clinical, emotional and sociodemographic factors contribute to their burden of suffering., Methods: A total of 177 outpatients with dizziness completed this cross-sectional study, in which the following measures were assessed of suffering rated using the PRISM tool; dizziness-related variables, like emotional distress (Hospital Anxiety and Depression-Scale, HADS); self-perceived severity of dizziness (Dizziness Handicap Inventory, DHI); and sociodemographic variables., Results: Regression analyses identified the strongest association between PRISM-rated suffering and DHI (p < 0.001), explaining 34% of the variance in PRISM-rated suffering. The HADS score and having continuous dizziness versus transient attacks each explained roughly 2% of the variance in suffering. No significant associations with PRISM-rated suffering were found for sociodemographic variables or other dizziness characteristics., Conclusions: The PRISM is applicable to patients suffering from dizziness, demonstrating a significant association with the severity of dizziness and reliably distinguishing between those with low and high intensities of dizziness. The PRISM also reflects the multi-factorial aspects of suffering. Due to its immediate, timesaving and economical use, the PRISM could enable clinicians to identify vulnerable patients at risk for chronic symptoms and distress. Whether the PRISM can detect improvements and worsening of symptoms during treatment warrants further research.

Purpose: The impact of vertigo and dizziness on healthy ageing, and especially on participation, is not fully understood. The objective of this study was to investigate the association of vertigo and dizziness with self-perceived participation and autonomy in older non-institutionalised individuals, adjusted for the presence of other health conditions. Specifically, we wanted to investigate the different effects of vertigo and dizziness on specific components of participation, i.e. restrictions in indoor and outdoor autonomy, family role, social life and relationships, and work and education., Methods: Data originate from the second wave of the German KORA-Age cohort study collected in 2012. Participation and autonomy was investigated with the Impact on Participation and Autonomy Questionnaire. We used robust regression to analyse the association of vertigo and dizziness with self-perceived participation and autonomy adjusted for covariates., Results: A total of 822 participants (49.6% female) had a mean age of 78.1 years (SD 6.39). Participation and autonomy were significantly lower in participants with vertigo and dizziness across all domains. Adjusted for age, sex, and chronic conditions, vertigo and dizziness were significantly associated with participation restrictions in all domains except social life and relationships., Conclusion: The results of our study indicate that vertigo and dizziness contribute to restrictions in participation and autonomy in individuals of older age. Recognising vertigo and dizziness as independent contributors to loss of autonomy and decreased chances for independent living may create new options for patient care and population health, such as the designing of complex interventions to maintain participation and autonomy.

Background: Dizziness in older people is associated with disability and reduced quality of life. Few studies have investigated how daily life is affected from the older person's perspective. Identifying barriers and resources in daily life could guide health care in how to direct efficient interventions. The aim of this study was to explore older persons' experiences of living with chronic dizziness., Methods: In this qualitative study seven women aged 74-84 years and six men aged 73-87 years with chronic dizziness (≥3 months) recruited from a primary health care centre in 2012 participated in semi-structured interviews. The interviews were analysed by content analysis., Results: Interpretation of the interviews resulted in the overall theme "Fighting for control in an unpredictable life" with two themes. The first theme "Striving towards normality" revealed a struggle in daily life in searching for a cure or improvement and finding a way to maintain ordinary life. This process could result in feelings of resignation or adaption to daily life, and factors that supported living with chronic dizziness were described. The second theme "Having a precarious existence" revealed that daily life included being exposed to threats such as a fear of recurrent attacks or of falling, which resulted in an insecure and inflexible way of life. A feeling that symptoms were not taken seriously was described., Conclusions: The present study showed that older persons with chronic dizziness have needs that are not met by health care. Despite the fact that frequent contact with health care was described, the respondents described barriers in daily life that led to a restricted, inflexible and insecure daily life. Health care should therefore be individually tailored with focus on aspects of daily life, especially safety aspects. Support should also be continued until the older persons with chronic dizziness have developed coping strategies to gain control of their daily life.

Background: Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown., Methods: The cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified., Results: Patients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%)., Conclusion: Both the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient's overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.

Background: Alexithymia is a personality trait characterized by deficits in regulating, experiencing and verbalizing emotions and has been assumed to be associated with a tendency to express emotional arousal through somatization. Although such a tendency is often observed in patients with dizziness, the exact relationship of alexithymia to dizziness is not yet known. The aim of this study was to examine alexithymic characteristics in patients with dizziness and its relation to health-related quality of life (HRQoL)., Sampling and Methods: We assessed 208 patients from an interdisciplinary center for vertigo and balance disorders for characteristics of alexithymia (20-item Toronto Alexithymia Scale), HRQoL (Short-Form 12 Health Survey, SF-12), dizziness (Dizziness Handicap Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were used to evaluate the relationship between alexithymia, dizziness and HRQoL., Results: We found that difficulties in identifying and describing feelings, two important factors of alexithymia, were significantly related to more severe symptoms of dizziness. More pronounced alexithymic characteristics were associated with lower HRQoL, especially in the mental dimension of the SF-12. The results remained significant after controlling for possibly confounding variables such as socioeconomic status and depression., Conclusions: These findings contribute to a better understanding of affect regulation in patients with dizziness, which is important for the development of psychotherapeutic interventions suitable for alexithymic patients with dizziness., (Copyright © 2012 S. Karger AG, Basel.)

Purpose: Relatively little is known about the level of impairment in patients with dizziness., Research Question: How much does dizziness impair the quality of life of patients referred to a multidisciplinary dizziness unit?, Patients and Methods: All 2,252 patients completed the Dutch version of the Dizziness Handicap Inventory (DHI-D; score 0-100 with higher scores representing more impairment). The results were classified into three categories: mild, moderate, and severe impairment. The three domains in the DHI representing physical, functional, and emotional aspects of dizziness were compared, as well as DHI scores of men versus women, between diagnoses, and the relationship between DHI and age., Results: A total of 2,242 patients (64% women, mean age 54 years) completed the DHI with a mean score of 40.6. Almost 70% of patients had moderate or severe complaints. The handicap perceived by patients was primarily caused by physical and functional factors and less by emotional factors. Female patients and patients with hyperventilation syndrome and/or anxiety disorder had significantly higher DHI scores on all subscales. There was an S-shaped relationship between DHI score and age, and older patients reported more impairment., Conclusion: Dizziness has considerable impact on health-related quality of life of dizzy patients.

Mood disorders and the severity of dizziness often interact with each other. However, the impact of age on anxiety and depression in dizzy patients has rarely been explored. The purpose of this study was to evaluate the correlation between the Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS) in a group of patients with dizziness. The statistical relationships between age and each scale were studied. This cross-sectional study revealed a high correlation between DHI subgroups and HADS subscales. We found statistical correlation between neither age and HADS subscales nor age and DHI subgroups. In addition, Short-Form 36 Health Survey Questionnaires (SF-36) showed a high correlation with the dizziness handicap severity. The present study revealed that age does not influence mood disorders and the severity of dizziness in dizzy patients., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: Dizziness is frequent in elderly people., Aims: To evaluate the Quality of Life (QoL) in elderly subjects with dizziness, relate it with gender and age., Material and Method: A prospective study comprising 120 elderly patients with dizziness evaluated with Brazilian versions of the Whoqol-bref and the dizziness handicap inventory (DHI). The factor analysis (FA), the Mann Whitney and Kruskal Wallis tests, and the Spearman correlation were applied to study the results., Results: The most compromised domains were the DHI physical domain and the Whoqol-bref physical and environment domains. FA resulted in 3 factors in the DHI and 5 factors in the Whoqol-bref. There was a moderate correlation (-0.596) in the total scores of both instruments. Males had a better QoL in the "environment perception and introspectivity" and "health perception" factors of the Whoqol-bref test. Females had a better QoL in the "functionality perception" factor of the Whoqol-bref test. There were no significant age differences., Conclusions: Elderly patients with dizziness have a worse QoL. Elderly females with dizziness have worse QoL scores in "environment perception and introspectivity" and "health perception" and better QoL in the "functionality perception" factor compared to elderly males.

Background: Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing., Aim: This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community., Setting and Design: Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria., Method: Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment., Result: Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65-69 years, 91 (28.6 per cent) 70-74 years, 66 (20.8 per cent) 75-79 years and 122 (38.4 per cent) > or =80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument., Conclusion: Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

Background: Dizziness has a clear impact on quality of life of patients. Standardized instruments such as the "Dizziness Handicap Inventory" (DHI) help clinicians assess this impact systematically. The purpose of this study was to analyse the psychometric quality of a German version of the DHI., Methods: One hundred and five patients with dizziness as their primary complaint have completed the DHI and undergone vestibular examination. The structure of the DHI was determined with a factor analysis, a principal component analysis with a Varimax rotation. To evaluate the reliability, internal consistency (Cronbach's alpha) was estimated., Results: A three-factor solution was extracted. The factors obtained from the German version of the DHI related to (1) activity and participation limitations (2) emotional problems and (3) motion sensitivity in everyday life of patients. Overall, there was a close correspondence of the factors of the German and the original version. The correlation analysis indicated a close relationship between the DHI-scores and the frequency of dizziness attacks., Conclusion: The German version of the DHI exhibited a multidimensional structure and good psychometric quality to assess the impact of dizziness in every day life.

Background: The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured., Methods: Two samples (n = 92 and n = 27) included participants with dizziness of mainly vestibular origin. A cross-sectional design was used to examine the factor structure (exploratory factor analysis), internal consistency (Cronbach's alpha), concurrent validity (Pearson's product moment correlation r), and discriminate ability (ROC curve analysis). Longitudinal designs were used to examine test-retest reliability (intraclass correlation coefficient (ICC) statistics, smallest detectable difference (SDD)), and responsiveness (Pearson's product moment correlation, ROC curve analysis; area under the ROC curve (AUC), and minimally important change (MIC)). The DHI scores range from 0 to 100., Results: Factor analysis revealed a different factor structure than the original DHI, resulting in dismissal of subscale scores in the DHI-N. Acceptable internal consistency was found for the total scale (alpha = 0.95). Concurrent correlations between the DHI-N and other related measures were moderate to high, highest with Vertigo Symptom Scale-short form-Norwegian version (r = 0.69), and lowest with preferred gait (r = - 0.36). The DHI-N demonstrated excellent ability to discriminate between participants with and without 'disability', AUC being 0.89 and best cut-off point = 29 points. Satisfactory test-retest reliability was demonstrated, and the change for an individual should be >/= 20 DHI-N points to exceed measurement error (SDD). Correlations between change scores of DHI-N and other self-report measures of functional health and symptoms were high (r = 0.50 - 0.57). Responsiveness of the DHI-N was excellent, AUC = 0.83, discriminating between self-perceived 'improved' versus 'unchanged' participants. The MIC was identified as 11 DHI-N points., Conclusions: The DHI-N total scale demonstrated satisfactory measurement properties. This is the first study that has addressed and demonstrated responsiveness to important change of the DHI, and provided values of SDD and MIC to help interpret change scores.

Purpose: The purpose of this study was to investigate the Quality of Life (QOL) and related factors in the patients with dizziness., Methods: The data were collected between March and June 2008 for 200 individuals who agreed to participate in the study. Uncertainty (Uncertainty in illness scale), anxiety, depression (Hospital anxiety & depression scale) and Vestibular disability activities of daily living (Vestibular disability-activities of daily living [ADL] scale) as well as QOL (Dizziness Handicap Inventory) were measured., Results: The mean QOL score was 37.5 (+/-23.0). Monthly income, etiology of, frequency of, and total duration of dizziness were the significant factors related to QOL in these patients. Having had a fall, anxiety, depression, uncertainty and vestibular disability in daily living were also significant factors influencing QOL. In multiple regression analysis, anxiety, vestibular disability-ADL, falls, total duration of symptoms, uncertainty, and etiology of dizziness explained 41% of variance of QOL., Conclusion: The level of QOL in our patients was moderate as compared to those in previous studies. Anxiety and vestibular disability were the most important factors predicting low QOL. Use of nursing intervention programs designed to relieve these factors should also result in improving the QOL in the patients with dizziness.

Unlabelled: Balance disorders affect social, family and professional activities. Vestibular rehabilitation can reduce the impact of these disorders on the quality of life of individuals with vertigo., Aim: to study the influence of vestibular rehabilitation on the quality of life of individuals, correlating it with gender, age, results from computerized vectoelectronystagmography and vertigo., Study Type: Retrospective., Materials and Methods: Twenty-two individuals were submitted to customized vestibular rehabilitation and the Brazilian Dizziness Handicap Inventory - DHI before and after vestibular rehabilitation. Results from this questionnaire were correlated with gender, age, vestibular assessment and the presence of vertigo., Results: all the DHI scores reduced significantly after vestibular rehabilitation. There were no differences among genders; adults and elderly patients; irritative peripheral vestibular syndromes; deficiency syndromes and normal exams; the presence or absence of vertigo., Conclusion: all the individuals had improvements in their quality of life after customized vestibular rehabilitation.

Background: Dizziness is a very common complaint. The frequency of dizziness increases with age. It affects quality of life negatively for older persons in several ways., Objectives: This study intended to investigate which variables (physical activity, loneliness, health complaints, need of help for daily living and falls) differed between those with and without dizziness and also to investigate which factors affected quality of life among older persons with dizziness., Method: An age-stratified, randomised sample of senior citizens - aged 75 or older - living in the south of Sweden (n = 4,360) answered a questionnaire concerning demographic data, social network, health complaints and diseases, feelings of loneliness, quality of life (Short Form 12), frequency of falls and activities., Results: Dizziness was associated with an increased risk of falling. Falls in the last 3 months were reported in 31% of the subjects with dizziness compared to 15% among those without (p < 0.001). Dizziness also correlated with depression, with 42.5% feeling depressed among the elderly reporting dizziness as compared with 13.2%. Exercise, both light (i.e. go for a walk) or heavy (i.e. work in the garden), correlated with reduced risk of low quality of life among older, dizzy persons, both mental (light exercise OR 0.58; heavy OR 0.48) and physical (light OR 0.62; heavy OR 0.21). The proportion of dizzy persons doing light exercise was 75.6% versus 87.4% among the not dizzy (p < 0.001). Exercise reduces the risk of falling and the risk of being depressed, and increases quality of life., Conclusion: Even light exercise seems beneficial both for improving quality of life and to decrease the risk of falling, which in turn will lower the mortality rate. Older persons reporting dizziness should be encouraged and perhaps helped to exercise. If one could increase physical activity among the elderly, it would reduce the number of falls, diminish medical costs, suffering for the individual, and be of paramount medicosocial importance for society.

Conclusion: Elderly patients with chronic dizziness had a poor HRQoL, which could be successfully assessed using the SF-36, a generic health-status instrument. The frequency of dizziness and comorbid psychological distress were predictive of impairment in QoL., Objectives: To evaluate health-related quality of life (HRQoL) and its relationship to characteristics of dizziness in elderly persons with chronic dizziness., Material and Methods: A standardized dizziness questionnaire was used to evaluate characteristics of dizziness as well as medical, functional and demographic data in 197 consecutive patients with chronic dizziness aged > or =60 years. HRQoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS)., Results: Compared with normative data, results from patients with dizziness indicated a pervasive multidimensional decline in SF-36 scores. This decline was most notable in terms of role limitations in the physical and emotional dimensions. The frequency of attacks of dizziness correlated with perceived disability. Patients with chronic dizziness also had great psychological distress, as measured by the HADS score, which had a detrimental influence on their QoL.

We assessed health-related quality of life (QoL) and depression, using the SF-36 and the Beck Depression Inventory (BDI), in 20 orthostatic tremor (OT) patients. All dimensions of the SF-36 were markedly reduced in OT and depression was found in 11 patients. The BDI score correlated significantly with several SF-36 subscores. We conclude that OT strongly impacts on QoL. The results highlight the importance of recognizing and treating depression in patients with OT.

The purpose of this study was to describe quality-of-life aspects in a group of patients (n = 99) suffering from peripheral vestibular disorder, using three different self-rated instruments, the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Sickness Impact Profile (SIP). The results showed that the type of dizziness that most influenced the quality-of-life aspects were: frequent short- or long-term dizziness, nausea, and the feeling that the ground was distant or as though the patient were walking on clouds. However, several of the impairments in daily life were neither related to the disease itself nor the demographic data. This verifies the necessity of investigating other factors such as personality and coping capacity. The results of this study also demonstrate the patients' need of psychosocial support. A comprehensive assessment and evaluation is important in order to identify each patient's needs.

Vertigo, dizziness and imbalance are frequent symptoms among patients in clinical practice. We present the development of a new multipurpose measure specific to patients with these symptoms: the VDI questionnaire. Items of the VDI questionnaire were generated through an international panel of clinicians, in-depth interviews with 25 patients and an extensive literature search. Items were reduced by qualitative and quantitative methods. Psychometric properties were tested in 130 patients recruited in primary care general practices, neurologists and ENT out-patient clinics. Patients were clinically evaluated and administered several specific and generic health status instruments: the Balance Scale, the SF-12 Health Survey and the General Health Questionnaire 12 items. The VDI symptoms and the VDI health related quality of life (HRQoL) scales were administered during the visit and some weeks after. Correlation and confirmatory factor analysis were used. Reliability of the VDI was high (0.92 for VDI HRQoL scale and 0.86 for VDI symptoms). VDI scores were more correlated with Balance Scale scores than with mental health indicators. All factor loadings were significantly different from zero and confirmed the expected relations. In the second administration, VDI scores showed a deterioration among those reporting a worsening in their symptoms and an improvement among those reporting feeling better. The data presented suggest that the VDI questionnaire is a reliable, valid and responsive instrument for patients with vertigo, dizziness or imbalance. The VDI questionnaire could be a useful complement of the clinical evaluation of these patients at both group and individual level.