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The Dizziness Handicap Inventory does not correlate with vestibular function tests: a prospective study

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Abstract

The Dizziness Handicap Inventory (DHI) is believed to quantitate the handicap related to the presence or severity of underlying vestibular dysfunction. However, patients with chronic vestibular diseases may manifest various degrees of behavioural and physiological adaptation resulting in variances of the DHI. Our primary study objective is to evaluate the correlation between the DHI and measurable vestibular parameters. Secondarily, we compared DHI among different vestibular disorders (central, peripheral and functional), and different types of anatomic deficits (semicircular canal vs otolithic). We also correlated the DHI and posturography. We prospectively evaluated 799 patients with precise vestibular diagnoses using video head impulse testing (vHIT), caloric irrigation, and cervical/ocular vestibular-evoked myogenic potentials (c/oVEMP). Posturography was done for 84 patients. All participants completed the DHI. No significant correlation was found between DHI and (1) vestibulo-ocular reflex parameters: unilateral weakness r = − 0.018, total calorics r = 0.055, vHIT right r = 0.007, vHIT left r = − 0.091, vHIT asymmetry r = 0.013; (2) otolith parameters: cVEMP amplitude right r = − 0.034, amplitude left r = − 0.004, asymmetry r = 0.016; oVEMP amplitude right r = 0.044, amplitude left r = − 0.007, asymmetry r = − 0.008. Patients with central vestibular disorders had higher DHI than those with peripheral (z = − 4.743, p = 0.001) or functional disorders (z = − 2.902, p = 0.004). DHI of patients with deficits of canal or otolith function did not differ significantly from those with no deficits (z = 2.153, p = 0.541). There was no significant correlation between DHI and postural sway on posturography. Therefore, the DHI does not correlate with vestibular tests, and neither reflects the presence nor severity of peripheral vestibular deficits.

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Acknowledgements

The study was funded by the German Ministry of Education and Research (BMBF) to the German Center for Vertigo and Balance Disorders (DSGZ)—Grant 01EO0901. We also thank Katie Ogston for editing the manuscript for grammatical correctness, and Siegbert Krafczyk for technical assistance with the posturography.

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Authors and Affiliations

  1. Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore

    Chun Wai Yip

  2. Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilian University, Munich, Germany

    Chun Wai Yip & Michael Strupp

Authors
  1. Chun Wai Yip
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  2. Michael Strupp
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Contributions

CWY wrote the manuscript, collated the data and performed the statistical analysis. MS conceptualised and designed the study, collected the data, and helped revised the manuscript.

Corresponding author

Correspondence to Chun Wai Yip.

Ethics declarations

Conflicts of interest

CW Yip reports no conflict of interest relevant to the manuscript. M. Strupp is Joint Chief Editor of the Journal of Neurology, Editor in Chief of Frontiers of Neuro-otology and Section Editor of F1000. He has received speaker’s honoraria from Abbott, Actelion, Auris Medical, Biogen, Eisai, GSK, Henning Pharma, Interacoustics, MSD, Otometrics, Pierre-Fabre, TEVA, UCB. He acts as a consultant for Abbott, Actelion, AurisMedical, Heel, IntraBio and Sensorion.

Ethical standards

This study was approved by the Hospital Ethics Committee and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants gave their informed consent prior to their inclusion in the study. There are no details in this manuscript that might disclose the identity of the participants.

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Yip, C.W., Strupp, M. The Dizziness Handicap Inventory does not correlate with vestibular function tests: a prospective study. J Neurol 265, 1210–1218 (2018). https://doi.org/10.1007/s00415-018-8834-7

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  • DOI: https://doi.org/10.1007/s00415-018-8834-7

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