Hybrid dizziness counseling with vestibular rehabilitation in participants with chronic dizziness: a comparison of dizziness handicap

Abstract

Abstract Introduction Patients with chronic dizziness often have unremarkable laboratory vestibular examination and have medical clearance from other specialties. However, functional impairments are still significant and affecting patients’ quality of life. Recent diagnostic criteria and identification of persistent postural perceptual dizziness (PPPD) has helped us to better understand the psychological-somatic manifestations of organic disorders. As the literature suggest good efficacy using a combination of cognitive behavior therapy (CBT) and vestibular rehabilitation, we compared the efficacy of a hybrid protocol using dizziness handicap inventory (DHI) as an outcome measure amongst the different sub-types of chronic dizziness. Methods Observational study of 35 participants allocated to three different groups, those who fulfilled strictly PPPD criteria, those with spontaneous episodic vestibular syndrome and participants with non-specific dizziness. We compared the DHI total and sub-domains scores at baseline and 6 months post-intervention for differences. All participants undertook three sessions in six months. Results DHI total scores were reduced in all three groups. However, DHI total on average was 11 points higher in the episodic vestibular syndrome group. Emotional sub-domain scores were also reduced in all three groups, but functional and physical scores were significantly higher in the episodic vestibular group. Conclusion Hybrid protocol works best for typical PPPD patients who strictly fulfilled criteria followed by participants in the non-specific dizziness group. When symptoms are episodic in spontaneous vestibular syndrome, only emotional handicap is reduced at 6 months, but functional and physical handicap scores remain high. Regardless DHI total scores in all groups are reduced significantly possibly because of CBT reducing anxiety from the lack of understanding of the clinical diagnoses.