Dizziness Handicap Inventory Questionnaire Research Articles

Assessment of Quality of Life in Patients with Balance Disorders Using Vertigo Symptom Scale–Short Form and Dizziness Handicap Inventory

Background: Dizziness is a common complaint presenting in general practice of ears, nose, and throat (ENT). Vertigo constitutes approximately 54% of cases of dizziness. This study aims at evaluating balance disorders with the aid of Vertigo Symptom Scale and Dizziness Handicap Inventory (DHI) to assess the quality of life in patients. Materials and Methods: This cross-sectional study was carried out on subjects that presented with complaints of vertigo to the ENT indoor patient department and outpatient department at the Yenepoya Medical College Hospital in Mangalore. Patients with known case of head injury, cardiovascular disease, seizure, and cervical spondylosis were excluded from the study. The patients were assessed for Vertigo Symptom Scale- Short Form vertigo balance subscale score (VSS-sf-V), Vertigo Symptom Scale-Short form autonomic anxiety subscale score (VSS-sf-A)and DHI questionnaire. Data obtained were recorded into MS Excel work sheets, and statistical analysis was done using IBM SPSS version 23 program running on windows operating system. P < 0.05 was considered statistically significant. Results: A total of 49 patients fulfilling the inclusion criteria were included, with a mean age of 44.16 ± 11.78 years, and among them, 25 were male and 24 were female patients. Diabetes was observed in 6.1% (n = 3), while 14.3% (n = 7) had diabetes and hypertension. Nearly 73.5% (n = 36) of the participants had no comorbidities. There was a significant association between complaints and DHI with P = 0.001. Whereas, there was no association between comorbidities and DHI with P = 0.334. Conclusion: The present study evaluated the participants based on Vertigo Symptom Scale–Short Form and DHI to assess the impact of vertigo on quality of life. The study showed a good utility of these questionnaires in assessing the quality of life.

New onset episodic vertigo as a presentation of vestibular neuritis.

ObjectiveVestibular neuritis (VN) is a common peripheral cause of acute vestibular syndrome, characterized by sustained vertigo and gait instability, persisting from 1 day to several weeks. With the widespread use of comprehensive vestibular function tests, patients with VN and non-sustained vertigo have drawn attention. In this study, we retrospectively analyzed the clinical presentation of patients with VN and episodic vertigo, aiming to expand the atypical clinical features of VN.MethodsThis retrospective study enrolled 58 patients with VN. Among them, 11 patients with more than 3 remissions per day, each lasting over 1 h were assigned to the episodic vertigo (EV) group, and 47 subjects without significant relief into the sustained vertigo (SV) group. Demographic information, clinical manifestations and data of supplementary examinations were collected and statistically analyzed. These patients were followed up 1 year after discharge to gather prognostic information.ResultsThe incidence of spontaneous nystagmus (SN) and proportion of severe vertigo (Dizziness Handicap Inventory questionnaire score >60) in the SV group were significantly higher than those in the EV group. Spearman correlation showed that with a longer disease course, the velocity of overt saccade was smaller (p < 0.05, Rs = −0.263) in all patients with VN.ConclusionThe non-sustained manifestations in VN overlap with a wider spectrum of other vestibular disorders and stroke-related vertigo, which add an additional layer of complexity to the differential diagnosis of new onset episodic vertigo. By retrospectively analyzing the clinical characteristics and vHIT parameters, our study has expounded on the atypical features and potential pathophysiological mechanism of episodic syndromes in VN. VOR gain and saccades measured by vHIT could be reliable indicators for vestibular rehabilitation process.

Head-shaking-induced nystagmus reflects dynamic vestibular compensation: A 2-year follow-up study.

PurposeWe aimed to assess the ability of a head-shaking test (HST) to reflect vestibular compensation in patients after unilateral peripheral vestibular loss and to provide missing evidence and new insights into the features of head-shaking-induced nystagmus (HSN) over a 2-year follow-up.BackgroundHSN may occur after a prolonged sinusoidal oscillation of the head. HSN is frequently observed in subjects with vestibular function asymmetry; it usually beats toward the functionally intact or “stronger” ear and can be followed by a reversal of its direction.Study designA prospective observational case-control study.SettingsA tertiary academic referral center.MethodsA total of 38 patients after acute unilateral vestibular loss (22 patients with vestibular neuronitis and 16 patients after vestibular neurectomy) and 28 healthy controls were followed for four consecutive visits over a 2-year period. A complex vestibular assessment was performed on all participants, which included spontaneous nystagmus (SPN), the caloric test, the head-shaking test (HST), the video head impulse test (vHIT), the Timed Up and Go (TUG) test, and the Dizziness Handicap Inventory (DHI) questionnaire. We established the criteria for the poorly compensated group to assess different compensatory behaviors and results.ResultsWe found a time-related decrease in HSN (ρ < −0.84, p < 0.001) after unilateral vestibular loss. After 2 years of follow-up, HSN intensity in compensated patients reached the level of the control group; TUG and DHI also improved to normal; however, the caloric and vHIT tests remained abnormal throughout all follow-ups, indicating a chronic vestibular deficit. Besides, poorly compensated patients had a well-detectable HSN throughout all follow-ups; TUG remained abnormal, and DHI showed at least a moderate deficit.ConclusionsOur study showed that, after a unilateral peripheral vestibular loss, the intensity of HSN decreased exponentially over time, reflecting an improvement in dynamic ability and self-perceived deficit. HSN tended to decline to the value of the control group once vestibular compensation was satisfactory and sufficient for a patient's everyday life. In contrast, well-detectable HSN in poorly compensated patients with insufficient clinical recovery confirmed the potential of HSN to reflect and distinguish between adequate and insufficient dynamic compensation. HSN could serve as an objective indicator of stable unilateral vestibular loss.

Translation, Cross-Cultural Adaptation, and Validation of the Polish Version of the Dizziness Handicap Inventory

ObjectivesThe Dizziness Handicap Inventory (DHI) questionnaire is used to assess the severity of vertigo. In clinical practice, it is a good indicator for understanding the patient’s feelings and can be used as a quantitative measure for monitoring ongoing treatment and rehabilitation. This study involved the translation, cultural adaptation, and validation of the Polish DHI questionnaire (DHI-POL). MethodsWe recruited 127 subjects (mean age 55.1 years) who experienced vertigo, dizziness, and imbalance resulting from a disturbance to their vestibular system that had lasted longer than 1 month and 56 subjects (mean age 51.8 years) without any vestibular symptoms. All subjects performed a posturography Sensory Organization Test and completed the questionnaire twice. ResultsCronbach’s alpha for the overall DHI-POL was α = 0.93. The questions were divided into 3 subgroups (functional [F], emotional [E], and physical [P]) for which the internal consistency was as follows: DHI-F, α = 0.84; DHI-E, α = 0.85; and DHI-P, α = 0.81. Reproducibility, as measured by interclass correlation coefficient for the overall DHI-POL, was 0.91. For each interclass correlation coefficient subgroup, the results were as follows: DHI-F, 0.90; DHI-E, 0.93; and DHI-P, 0.83. ConclusionsDHI-POL has a high consistency and repeatability; therefore, it is a fully functional questionnaire that meets all the validation criteria and is a tool ready for use on Polish patients with vertigo.

Vestibular Disability/Handicap in Fibromyalgia: A Questionnaire Study.

Fibromyalgia (FM) is a poorly understood, central pain processing disorder characterized by a broad range of symptoms, such as chronic pain, sleep disruption, chronic fatigue, and psychosomatic symptoms. In addition, recent studies have shown that FM patients also experience dizziness. We aimed to establish a prevalence rate of vestibular symptoms in a population of FM patients through a battery of questionnaires investigating socio-demographic, clinical and psychological characteristics, combined with the Dizziness Handicap Inventory (DHI) and the Situational Vertigo Questionnaire (SVQ). A total of 277 respondents, officially diagnosed with FM, completed the full study, while 80 controls were also included for DHI and SVQ questionnaires. We found that FM participants were significantly affected by vestibular symptoms, which correlated with FM-associated pain and non-pain symptoms. The dizziness reported by FM participants showed peculiar features suggesting an FM-intrinsic mechanism of vestibular dysfunction, possibly linked to migraine and dysautonomia conditions. Correlations between dizziness and depressive mood (or neuroticism), revealed an impact of dizziness on psychological status, leading to depressive reactions and interpersonal difficulties, and possibly involving a noxious, self-sustained stress condition. In conclusion, data showed a manifesting dizziness condition in FM patients that warrants careful clinical attention due to its possible inherent role in the syndrome.

Effectiveness of Ozone-Oxygen Mixture by Ultrasonography-Guided Facet Medial Branch Block in the Treatment of Cervicogenic Dizziness

Purpose: Among many central and peripheral causes of vertigo, one of the factors whose pathophysiology is not yet understood is cervicogenic dizziness (CD). There are studies reporting that CD may benefit from facet joint medial bundle branch block (MBB). The purpose of our study was to share our experiences of MBB application using ultrasonography (USG) in patients diagnosed with CD. Materials and Methods: After physical examination and necessary cervical imaging, C1, C2 and C3 cervical facet joint MBB and ozone injection were performed using USG for patients who had vertigo and accompanying cervical pathology and neck pain. In order to evaluate the effectiveness of the treatment, pain levels with the Visual Analog Scale (VAS) and the effect of vertigo on the quality of life with the “Dizziness Handicap Inventory (DHI)” Turkish validation questionnaire were documented. Results: Thirty-five patients who met the criteria were included in the study. The mean age of the patients was 50.8 ± 10.7. Of the 35 patients, 10 (28.6%) were male and 25 (71.4%) were female. There was a significant difference between the preoperative period and the postoperative 1st, 2nd, and 6th week VAS scores. A significant difference was found between the preoperative and the postoperative 2nd and 6th week DHI questionnaire survey results as well. Conclusions: In the follow-up after the procedures, it was observed that vertigo complaints of the patients decreased significantly.

Assessment of residual dizziness after successful canalith repositioning maneuvre in benign paroxysmal positional vertigo patients: a questionnaire-based study.

The purpose of this study was to assess residual dizziness (RD) after successful canalith repositioning maneuvre (CRM) treatment in patients with benign paroxysmal positional vertigo (BPPV) using Dizziness Handicap Inventory (DHI) questionnaire and Visual Analog Scale (VAS). One hundred sixty BPPV patients after successful CRM treatment were recruited. All patients were divided into the residual dizziness (RD) group and without RD group. The DHI questionnaire and VAS before CRM and follow-up were asked to complete. For analysis of the improvement in symptom, we defined ∆DHI and ∆VAS as the difference between the baseline score and the follow-up score. High incidence of RD was observed in the older patients (p < 0.001). The incidence of hypertension in the RD group was also significantly higher than that of the without RD group (p = 0.022). The ∆DHI-P, ∆DHI-E, ∆DHI-F, ∆DHI-T, and ∆VAS scores in the without RD group were significantly higher than that of the RD group (p < 0.001). When the cutoff point of the ∆DHI total scores was 17, the sensitivity was 64.86% and the specificity was 73.26% for diagnosing RD. When the cutoff point of the ∆VAS scores was 2.5, the sensitivity was 77.03% and the specificity was 81.40% for diagnosing RD. RD is prone to occur in the older patients and ∆VAS exhibits higher sensitivity and specificity in assessing RD.

Otoneurological assessment and quality of life of individuals with complaints of dizziness and temporomandibular disorders: a case-control study

ObjectivesTo evaluate the impact of temporomandibular disorders on the quality of life of patients with dizziness. MethodsAn observational, case-control study evaluated 60 individuals with dizziness (20 cases and 40 controls), who were matched for gender and age. The individuals underwent to anamnesis, overall physical and otoneurological examination, tonal and vocal audiometry and impedanciometry, video head impulse test and the dizziness handicap inventory questionnaire. ResultsThe otoscopy was normal for all patients. There was an association between the presence of temporomandibular disorders and aural fullness (p < 0.01) and otalgia (p < 0.01). Audiometry was normal in 90% of the patients in the case group, with a significant association between temporomandibular disorders and normal audiometry (p < 0.01). The video head impulse test findings were normal in 66% of the patients in the case group and 45% of the control group, and there was no association between having temporomandibular disorders and vestibular alterations at the video head impulse test (p = 0.12). There were significant differences in total dizziness handicap inventory and in the functional and emotional domains (p < 0.01), with higher scores in the control group. ConclusionAural fullness and otalgia symptoms are associated with temporomandibular disorders in patients with dizziness, and there is an association between normal complementary audiological tests and temporomandibular disorders. Vestibular alterations are not associated with temporomandibular disorders. However, patients with dizziness and without temporomandibular disorders showed greater quality of life impairment. Level of evidence3. Original case-control study.

Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders

PurposeTo contrast the quality of life (QoL) impairment and depression scores of patients suffering from different vestibular disorders.Methods301 patients were examined due to vertiginous complaints at the Neurotology Centre of the Department of Otolaryngology and Head and Neck Surgery of Semmelweis University. These patients completed the Hungarian version of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory, and the Symptom Checklist-90-Revised questionnaires.ResultsAccording to neurotological examination, the distribution of the different diagnoses was as follows: Menière’s disease (n = 101), central vestibular disorders (n = 67), BPPV (n = 47), vestibular neuritis (n = 39), other unilateral peripheral vestibulopathy (n = 18), PPPD (Persistent Postural-Perceptual Dizziness) (n = 16), vestibular migraine (n = 8), and vestibular Schwannoma (n = 5). The results of the DHI questionnaire have indicated worsened QoL in 86.4%, out of which 33.6% was defined as severe. The Beck scale has shown depressive symptoms in 42.3% of the cases, with severe symptoms in 6.3%. Significantly higher total DHI and Beck scale results were observed in patients with central vestibular disorders, vestibular migraine, PPPD and peripheral vestibulopathy, contrasted to the results of the other four diagnosis groups. The onset of the symptoms did not significantly affect the severity of QoL worsening and depression symptoms.ConclusionIn this study, the QoL of vertiginous patients was worse in general, with the occurrence of depression symptoms. A difference was observed in the case of the values of patients with different vestibular disorders, indicating the importance of different factors, e.g., central vestibular compensation, behavioural strategies and psychological factors.

Innovative System for Evaluation and Rehabilitation of Human Imbalance.

&lt;b&gt;Introduction:&lt;/b&gt; Mobile posturography is based on wearable inertial sensors; it allows to test static stability (static posturography) and gait disturbances. &lt;/br&gt; &lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of this work was to present the results of research on the innovative MEDIPOST system used for diagnosis and rehabilitation of balance disorders. &lt;/br&gt; &lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; Fourteen articles published in influenced foreign journals were presented and discussed. The deve-lopment and construction of the device was preceded by a literature review and methodological work. The Dizziness Handi-cap Inventory (DHI) questionnaire was translated and validated. The methodology of posturography with head movements with a frequency of 0.3 Hz was also developed in the group with chronic vestibular disorders. Simultaneous measurements were performed (static posturogrphy vs. MEDIPOST) in the CTSIB-M (Modified Clinical Test of Sensory Interaction in Balance) test in healthy subjects and patients with unilateral peripheral dysfunction.&lt;/br&gt; &lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; In the posturography with head movements the improvement of sensitivity (67 to 74%) and specificity (65 to 71%) was noted. In the CTSIB-M test the intraclass correlation coefficients for both methods were 0.9. The greatest differences between examinations were observed for the mean angular velocity in the tests on the foam (trials no. 3 and 4), in particular on the foam with eyes closed (trial no. 4 - sensitivity 86.4%, specificity 87.7%). Two functional tests were analyzed: the Swap Seats test and the 360 degree turn test. In the former, the results are studied from 6 sensors - 86% of the true positives and 73% of the true negatives for the fall/ no-fall group classification. The second test differentiates people with vestibular impairment and healthy people. It can be analyzed with 1 (sensitivity 80%) and 6 sensors (sensitivity 86%, specificity 84%). Currently, the MEDIPOST device is in the development and certification phase.

Interface entre as medidas de benefício após a reabilitação vestibular – relato de casos

ABSTRACT The purpose of this research is to characterize the vestibular rehabilitation (VR), vestibulo-ocular reflex (VOR) gain, the occurrence of compensatory saccades, the static and dynamic balance, and the impact on quality of life in three patients with peripheral vestibular hypofunction. This is a descriptive study, approved by the ethics in research committee, under number 4,462.519. Three female patients participated in the study, two aged 55 and one aged 67, with a medical diagnosis of peripheral vestibular dysfunction. The participants underwent anamnesis, Dizziness Handicap Inventory (DHI) questionnaire, clinical assessment of postural balance and Video Head Impulse Test (vHIT), pre and post VR. The VR was applied in a personalized manner, based on the Cawthorne and Cooksey protocol, associated with virtual reality stimuli. After VR, a reduction in the total score average of DHI was observed, suggesting a decrease in participation restriction. The clinical balance assessment results were within the normal range for the altered tests, pre VR. In the three evaluated cases, vHIT showed increased RVO gain for the previously affected semicircular ducts (SCDs), compatible with normality standards, and reduction or extinction in the occurrence of compensatory saccades. The increase in VOR gain and the reduction or suppression of compensatory saccades after VR are suggestive signs of vestibular compensation. These results were compatible with increased postural stability and less restricted quality of life. These findings demonstrate the benefit provided by VR in the three evaluated cases.

Higher incidence of Ménière’s disease during COVID-19 pandemic: a preliminary report

Background Coronavirus disease 2019 (COVID-19) pandemic represented a stressful event. Objectives The incidence of newly diagnosed Ménière’s disease (MD) patients before and during COVID-19 at our Institution was calculated. Materials and methods The period 2018–2020 was considered. Incidence was calculated as number of annual first MD diagnoses divided by the number of annual first audiological evaluations. Results One hundred and eighty-three patients were considered. Annual incidence of MD at our institution was 1.3% in 2018, 1.2% in 2019, and 3.2% in 2020, resulting in a significant increase during COVID-19 pandemic (2018 vs. 2020, p=.00001; 2019 vs. 2020, p=.00001). MD patients in 2020 presented a higher number of vertigo attacks (2018 vs. 2020, p=.04; 2019 vs. 2020, p=.04) and higher Dizziness Handicap Inventory questionnaire (DHI) values (2018 vs. 2020, p=.02; 2019 vs. 2020, p=.03). During COVD-19 pandemic, MD patients reported significantly higher State-Trait Anxiety Inventory (STAI) – Y1 (2018 vs. 2020, p=.04; 2019 vs. 2020, p=.03). Conclusions and significance A higher incidence of MD first diagnosis was calculated during COVID-19 pandemic; furthermore, MD patients presented with more vertigo attacks and higher DHI values. These could be associated with the higher state anxiety during COVID-19 pandemic.

Effects of hormone therapy containing 2 mg drospirenone and 1 mg 17β-estradiol on postmenopausal exacerbation of Meniere's disease: Preliminary study.

The present study aimed to evaluate the effects of 2 mg drospirenone (DRSP) and 1 mg 17β-estradiol (E2) hormone therapy (HT) in combination with rehabilitation therapy for postmenopausal women with Meniere's disease (MD). The combined drug hormone treatment was denoted as DRSP/E2. A total of 65 postmenopausal female patients with MD and severe distress were enrolled in the present prospective study. A total of 31 women comprised the study group (group A), undergoing HT and rehabilitation therapy, whereas 34 women who opted for rehabilitation therapy alone comprised the control group (group B). Vestibular function and distress associated with MD were assessed by stabilometry and the Dizziness Handicap Inventory (DHI) questionnaire, respectively. The data were collected at baseline and during the 3- and 6-month follow-up visits. The areas of the stabilometric ellipses exhibited a higher reduction in group A compared with group B with regard to the baseline values at both follow-up assessments (P<0.001). At baseline, both groups exhibited severe self-perceived discomfort, with similar DHI scores of 72.3±3.7 (group A) and 70.6±3.9 (group B; P=0.07). At the 3-month follow-up, both groups underwent a gradual improvement, which was significantly higher in group A (47.5±3.7) compared with in group B (64.2±3.3; P<0.001). At the 6-month follow-up, the DHI scores were improved in group A (43.4±3.4) compared with in group B (58.5±3.1; P<0.001). Therefore, DRSP/E2 HT was effective in reducing the fluid overload, which is characteristic of MD. The findings of the present study demonstrated that integrated therapy based on the administration of DRSP/E2 HT and rehabilitation may be more effective compared with rehabilitation alone for the management of postmenopausal exacerbation of MD.

Assessment of the patients’ quality of life visiting the emergency department with dizziness

Dizziness and vertigo are among the most common complaints in the emergency department. This may require interdisciplinary cooperation due to their complex presentation in the department and the effects on the patients' quality of life. Our study aimed to assess the effect of an acute vertigo episode on the quality of life after patients' discharge from the emergency department. 879 patients examined at the Semmelweis University emergency department with vertigo and dizziness were included in the study. A questionnaire, including the Dizziness Handicap Inventory (DHI), was addressed to this population. We received 308 answered questionnaires back (110 males, 198 females; mean age 61.8 years ± 12.31 SD), which were further analyzed. The most frequent diagnoses were benign paroxysmal positional vertigo, central lesions and dizziness. According to the analysis of the DHI questionnaire, a difference between physical, functional and emotional scores was shown, whereas the highest scores were registered in the physical group. The DHI questionnaire scores of patients undergoing a neurotological examination and those who did not were further compared, whereas no significant statistical difference was indicated (p = 0.97). In addition, an increase in DHI scores was seen depending on the time elapse for the definitive diagnosis. The absence of adequate examination and a late diagnosis of the dizziness cause have a significant impact on the quality of life of patients. Therefore, substantial investigation, early diagnosis, and detailed vestibular examination are essential, but the latter should take place in justified cases. Orv Hetil. 2021; 162(30): 1216-1221.

Comparison of Treatment Results for Clinical Types of Benign Paroxysmal Positional Vertigo

Objective: To compare the clinical characteristics and treatment results of different clinical types of benign paroxysmal positional vertigo (BPPV). Methods: A total of 162 patients diagnosed with BPPV between January 2019 to January 2021 at EMJJ ENT Hospital’s vestibular laboratory in Mongolia were included in our study. The diagnosis of BPPV was made according to the 2017 AAO-HNS clinical practice guideline for BPPV. Clinical questionnaires, Dizziness Handicap Inventory (DHI) questionnaires, and videonystgamography were obtained for all patients. Results: From a total of 162 patients diagnosed as BPPV, 62.4% had posterior canal BPPV, 27.1% had horizontal canal BPPV, and 10.5% had anterior canal BPPV. Fischer’s exact test showed a higher incidence on the right side (p = 0.000). The mean age 50 ± 11.7; the male to female ratio 1:4. When the relationship between the effectiveness and duration of the treatment was assessed, 123 (75.9%) recovered after 7 days. DHI score after treatment significantly after treatment (p = 0.000) regardless of the clinical type. Conclusions: Patients who had a longer duration of symptoms underwent unnecessary diagnostic tests and developed additional psychologic problems. There were no statistically significant differences when we compared the characteristics and treatment between the three clinical types of BPPV.

Is regression gain or instantaneous gain the most reliable and reproducible gain value when performing video head impulse testing of the lateral semicircular canals?

BACKGROUND: Several different video Head Impulse Test (vHIT) systems exist. The function of each individual semicircular canal (SCC) may be determined by performing this test. All vHIT systems provide information about the function of the vestibular ocular reflex by means of two modalities: SACCADES and GAIN. However, different gain calculation methods exist. OBJECTIVE: Primary endpoint: • Is instantaneous gain or regression gain the most reproducible and reliable gain value when performing vHIT with testing of the lateral SCCs? Secondary endpoints: • Comparison of each of the instantaneous gain values at 40, 60, and 80ms with the regression gain. • Examination of any intra- and inter examiner variability. • Mean instantaneous gain values, and at different velocities, compared with regression gain values of the lateral SCCs. METHODS: 60 subjects between 18–65 years were included. All patients filled out the Dizziness Handicap Inventory (DHI) questionnaire and underwent four separate vHIT tests, two by an experienced neurotologist and two by an inexperienced examiner. RESULTS/CONCLUSIONS: 240 datasets were obtained, displaying both regression and instantaneous gain values. Regression gain was more reproducible than instantaneous gain. The experienced examiner provided the most reproducible results. When comparing instantaneous gain, we found the gain at 40 ms to be the least reproducible. There was no significant difference between 60 ms and 80 ms.For both examiners no significant intra examiner variability was found.

Treatment Results of Definite and Probable Meniere's Disease

Objectives: To evaluate the treatment results of definite and probable Meniere's disease (MD). Methods: A total of 51 patients, who were diagnosed with Meniere's disease (MD) between January 2019 to January 2021 at EMJJ ENT hospital's vestibular laboratory in Mongolia, was included in our study. The diagnosis of Meniere's disease was according to the 2015 Diagnostic criteria of Meniere's disease of the Classification Committee of the Barany Society. The clinical dizziness handicap inventory (DHI) questionnaire was taken, and videonystagmography (VNG), caloric test, and PTA was done in all patients. Results: Of a total of 51 patients, 9 were diagnosed as probable MD, and 42 were diagnosed as definite MD. The mean age of the patients was 43.7, male to female ratio was 1:1.8, 37 (72.5%) patients were in treatment group I who all received medication only, and 14 (27.5%) patients were in treatment group II who were refractory to prior medical therapy underwent ITDL Comparing the two treatment groups, there were significant differences in all test results (p = 0.000). After ITDI hearing improved (p = 0.000). Conclusions: VNG, caloric test, and DHI questionnaire results show that both medical treatment and ITDI are successful in improving vestibular function.

The effect of vestibular rehabilitation on balance function and disability of adults with benign paroxysmal positional vertigo of posterior semicircular canals

Background and objective: Benign Paroxysmal Positional Vertigo (BPPV) is known as the most common cause of vertigo. Vestibular rehabilitation is an effective therapeutic option for patients with significant balance problems. The purpose of this study was to evaluate the degree of balance problems caused by BPPV as well as the effect of vestibular rehabilitation exercises on reducing the problems of this group of patients. Methods: In this clinical trial study, 30 patients with posterior semicircular canal BPPV were studied. All patients underwent vestibular rehabilitation therapy using Epley repositioning maneuver method. The effect of balance problem on their quality of life and handicap before and two months after the intervention was assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Results: The handicap degree of the BPPV patients before therapy was at mild level. The highest and lowest scores were related to physical and emotional dimensions of DHI with values of 13.58 and 6.46, respectively. DHI scores significantly decreased following two months therapy (P <0.001). This highest and lowest improvement was observed in functional (mean change: 13.58) and emotional (mean change: 6.46) dimensions, respectively. Conclusion: Vestibular rehabilitation is a beneficial approach for adults with unilateral BPPV of posterior semicircular canals. Through early diagnosis and intervention of vestibular disorders, the disability and handicap experienced by BPPV patients will be significantly reduced. Furthermore, the negative effects of this disease on the physical, functional and emotional aspects of patients will be noticeably diminished.

Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients.

(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix–Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients’ psychological status.

Physical Therapy for Benign Positional Vertigo of Posterior Canal: The Role of Alternated Epley and Semont Maneuvers.

To investigate if alternated Epley (EP) and Semont (ST) maneuvers could be more effective than repetition of the same in benign paroxysmal positional vertigo of posterior semicircular canal (pBPPV). We retrospectively reviewed the outcome of pBPPV patients treated with a second maneuver for the persistence of positional nystagmus. Forty-seven patients underwent 2 STs, 64 with 2 EPs, and 71 EPs followed by ST. Videonystagmography and Dizziness Handicap Inventory (DHI) questionnaire were performed. Absence of positional nystagmus was achieved after 2 maneuvers in 136 patients with pBPPV: 65.9% in the ST group, 70.3% in the EP group, and 84.5% in the EP-ST group. Alternated EP and ST were significantly more effective than repeated ST (P = .03), while we found no significant difference when compared with repeated EP (P = .07). At 1-month follow-up, 12 patients showed persistent positional nystagmus without difference between groups. After 1 month, the 46 patients with negative outcome had significantly higher DHI values (P = .01) than other 136 patients with pBPPV. Alternated EP and ST seemed more effective than repeating the same maneuver in treating pBPPV, and this should be confirmed in prospective clinical studies. Resolution of nystagmus after maneuvers was fundamental to reduce handicap deriving from dizziness as reported in DHI.