Introduction:
The term ”dizziness” refers to an unpleasant disturbance of spatial
orientation while vertigo refers to an erroneous perception of movement
which involves movement either of one’s own body, such as swaying or
rotation, or of the environment, or both. Vertigo and dizziness are one
of the common symptoms presented to physicians. Their lifetime
prevalence is approximately 20% to 30% [14, 20]. Its prevalence
rises with age and is about two to three times higher in women than in
men [14]. It is usually benign and self-limiting. Vertigo /
dizziness is associated with many causes- hypotension, dehydration,
Meniere’s disease; to more serious brain tumor, stroke, myocardial
infarction, etc.
International Classification of Vestibular Disorders I (ICVD-I) by the
Committee for the Classification of Vestibular Disorders of the Barany
Society classified vertigo and dizziness based on the description as (i)
Vertigo (ii) Dizziness (iii) Vestibulo-visual symptoms (iv) Postural
symptoms [2]. Because vertigo and dizziness are often triggered
symptoms and many vestibular disorders are identified by the presence
(or absence) of particular triggers; it further classified vertigo and
dizziness as ‘Triggered’ and “Spontaneous’ [2].
Targeted history taking, clinical bedside examinations, functional
testing of the vestibular system, and imaging are instrumental for
correct diagnosis and therapy management [24]. Wuyts, Floris L et al
developed a ‘SO STONED’ questionnaire tool for dizziness/vertigo
assessment and differential diagnosis; based on their experience and
literature [24]. It encompasses set of eight independent but closely
related dimensions necessary to discriminate between several diagnoses.
The acronym ‘SO STONED’ stands for, S: symptoms, O: often, S: since, T:
trigger, O: otology, N: neurology, E:evolution, D:duration. Trigger is
an important aspect for differential diagnosis. ‘Trigger’ refers to a
specific act or situation that provokes or aggravates the symptoms and
are important for the differential diagnosis for vertigo / dizziness.
Vestibular problems due to BPPV should cause vertigo upon lying down,
and also during the upright movement; but if the problem occur only
during the upright movement, then the probable underlying cause could be
of cardiac origin such as orthostatic hypotension [24].
Although dizziness is a non-specific symptom, it affects patient’s
quality of life (QOL). Bronstein, Adolfo M et al evaluated QOL and
social impact of dizziness in the cities, and its findings highlighted
the high social and economic impact of dizziness [3]. Subjectivity
of the dizziness makes it difficult for the clinicians to quantify it.
The Dizziness Handicap Inventory (DHI) is one of the most popular
questionnaires for assessment and grading of the dizziness [11]. It
was developed by Jacobson GP and Newman CW. The DHI is a self-reported
questionnaire designed to determine dizziness-dependent changes grouped
into three domains: Functional (36 points), emotional (36 points), and
physical (28 points) (Total score range 100-0). Higher the score more
the perceived handicap because of the vertigo / dizziness [6]. It is
used to assess QOL. We have used DHI score for the evaluation of the
treatment as well as QOL impact in our study.
The present study was conducted to review the common disorders related
to dizziness, its impact on QOL and management.