Evaluation of Self-reported Symptoms in 1,457 Dizzy Patients and Associations With Caloric Testing and Posturography

Objective: To determine if symptoms regarding timing and triggers of dizziness are useful for categorizing patients with dizziness, and to evaluate how patient-reported symptoms predict vestibular asymmetry, postural sway, and vestibular diagnoses. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Patients referred for suspected vestibular disease. Interventions: Patients completed a symptom questionnaire before laboratory testing with static posturography and bithermal caloric tests. Main Outcome Measure: Evaluate whether responses from a symptom questionnaire predict caloric asymmetry, postural balance, and diagnoses. Results: One thousand four hundred fifty seven patients, 60.1% women, mean age 49.9 (+/- 16.6) years were included. Vomiting was the strongest predictor for caloric asymmetry in adjusted analysis, odds ratio (OR): 1.60 (95% confidence interval [CI]: 1.24-2.06), followed by chronic hearing loss OR: 1.59 (1.19-2.13). Patients who reported constant dizziness had impaired postural balance, quantified as 15% increase in postural sway in adjusted analyses (7.25-24.6%). We found no association between caloric asymmetry and postural instability with eyes closed. Conclusion: Most patients were able to describe the timing of their symptoms and a categorization based on timing seems feasible. There seemed to be an over-reporting of triggers and confirmatory testing of triggers is therefore advocated. Vomiting, but not nausea, was a strong indicator of vestibular disease in this primarily outpatient population. Caloric asymmetry and postural balance were not associated, and assessment of fall risk may be warranted in patients who reports constant dizziness, visual disturbances or dizziness triggered by light, darkness or sounds.