Questionnaires for dizziness and hearing symptoms

Timothy C. Hain, MD• Page last modified: September 24, 2022 •

It is often useful to get a formal measurement of subjective symptoms accompaning a hearing and balance disorder. As migraine is commonly a source of dizziness, measuring headache symptoms is also useful.

These questionnaires are generally published in publically accessible journals, and for this reason, they are not proprietary.

Questionnaire used to quantify balance dysfunction	Link to questionnaire	Source
Activities specific Balance Confidence Scale (ABC)		Powell and Meyers, 1995; Whitney et al, 1999
Berg Balance Scale. This is commonly used.	https://www.strokecenter.org/trials/scales/berg.html	Berg et al, 1989.
Chambliss Mobility Inventory (for Agoraphobia).	Chamblis (pdf)	Chambliss et al, 2011
Dizziness Handicap Inventory. The DHI is commonly used.	DHI itself (online version)	Jacobson and Newman, 1990, and several others below.A discussion of DHI norms is here.
Hearing questionnaire (NIH version)	https://www.nidcd.nih.gov/health/hearing/10ways.asp
Falls efficacy scale.		Tinetti, Richman et al. 1990
Impact test (a concussion symptom score)		Impact test
Modified falls efficacy scale (MFES)		Hill, Schwartz and others, 1996
Mal de Debarquement (online) calculator	MdDS calculator	Adapted from Cha, Y. H., et al. (2020).
Medical outcomes study short form 36 (SF-36).	SF-36.	Enloe and Sheilds, 1997.
Menieres disease calculator	Menieres calculator
PPPD (online) calculator	PPPD calculator	Adapted from consensus criteria of Staab et al, 2017
Tinnitus Handicap Inventory/Questionnaire(THI description)	THI (pdf)	Comment: This is not a diagnostic test. It is a measure of distress.
Vestibular Migraine Calculator	VM calculator	Adapted from Lempert et al, 2012

Caveats:

None of the questionaires or surveys make "diagnoses". Some have unfortunate names, as if they did make diagnoses. For example, the Migraine disability assessment. One might wrongly think that someone who scores highly on this survey has migraine. Perhaps they have something else -- like a subdural, a brain tumor, a sinus infection ...

Pursuing this idea, it is important not to confuse a symptom inventory with a diagnosis. In other words, someone who scores highly on, lets say, the "Concussion Impact Inventory", doesn't necessarily have a concussion. They have some symptoms that people with concussion have.

The difficulty here lies in diagnoses that are all symptoms. For example, lets take migraine, PPPD or MdDS. These are diagnoses based on what a patient tells you - -symptoms. It is not based on a blood test, a genetic test, or a brain image.

Or to put this another way, not everyone who has a headache, is having a migraine. Not everyone who is confused has Alzheimer's disease. Not everyone who had a ping-pong ball drop on their head (i.e an impact), and has headaches has a concussion.

See also separate pages on cognitive and headache questionnaires.

Some aggregate data:

Our clinical "dizzy" practice in Chicago uses the DHI frequently. For our population of dizzy patients, the median score is about 40 (out of a total of about 1790 patients). This data is from the begining of 2018. These are not "normal" people -- these are mainly people with dizziness. A larger collection is found here.

DHI

We also have a large repertoire of patients with tinnitus, where we have obtained the THI. For these, the distribution is much different (n=854). This data is from the beginning of 2018. These are mainly people who are dizzy, and whose chief complaint is not tinnitus at all. There may be a few who are mainly being seen for tinnitus however.

THI

So for the Dizziness Handicap Inventory, nearly everyone who is coming to see us in the "dizzy clinic" feels handicapped. For the Tinnitus Handicap Inventory, rather few dizzy people are in a lot of distress.

There are also numerous tasks used to quantify balance. These primarily involve having people stand in such a way that balance is challenged, and measuring their missteps. Examples are:

BESS (balance error scoring system)
Duncan Reach test.
Fregley ataxia battery
CISS or "Foam and Dome"

References

Berg K, Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: Preliminary development of an instrument.
Physiotherapy Canada, 41:304-311, 1989.
Chambless, D.L., Caputo, G.C., Jasin, S.E., Gracely, E.J., & Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy, 23, 35-44. Original paper on the development of the scale, reliability, discriminative validity, treatment sensitivity, and concurrent and construct validity.
Chambless, D. L., Sharpless, B. A., *Rodriguez, D., McCarthy, K. S., Milrod, B. L., Khalsa, S.-R., & Barber, J. P. (2011). Psychometric properties of the Mobility Inventory for Agoraphobia: Convergent, discriminant, and criterion-related validity. Behavior Therapy, 42, 689-699. doi: 10.1016/j.beth.2011.03.001.
Cha, Y. H., et al. (2020). "Mal de debarquement syndrome diagnostic criteria: Consensus document of the Classification Committee of the Barany Society." J Vestib Res 30(5): 285-293.
Cohen, H. S., et al. (2000). "Development of the vestibular disorders activities of daily living scale." Arch Otolaryngol Head Neck Surg 126(7): 881-7.
Cohen, H. S., et al. (2000). "Application of the vestibular disorders activities of daily living scale." Laryngoscope 110(7): 1204-9.
Enloe, L. J. and R. K. Shields (1997). "Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures." Phys Ther 77(9): 890-903.
Hill, K. D., J. A. Schwarz, et al. (1996). "Fear of falling revisited." Arch Phys Med Rehabil 77(10): 1025-9.
Jacobson, G. P. and J. H. Calder (1998). "A screening version of the Dizziness Handicap Inventory (DHI-S)." Am J Otol 19(6): 804-8.
Jacobson, G. P. and C. W. Newman (1990). "The development of the Dizziness Handicap Inventory." Arch Otolaryngol Head Neck Surg 116(4): 424-7.
Jacobson, G. P., C. W. Newman, et al. (1991). "Balance function test correlates of the Dizziness Handicap Inventory." J Am Acad Audiol 2(4): 253-60.
Jacobson G, Calder J (1998) A screening version of the dizziness handicap inventory. American J. Otology 19(6) 804-808
Lempert, T., et al. (2012). "Vestibular migraine: diagnostic criteria." J Vestib Res 22(4): 167-172.
Powell, L. E. and A. M. Myers (1995). "The Activities-specific Balance Confidence (ABC) Scale." J Gerontol A Biol Sci Med Sci 50A(1): M28-34.
Saxena A, Prabhakar MC.Performance of DHI score as a predictor of benign paroxysmal positional vertigo in geriatric patients with dizziness/vertigo: a cross-sectional study. PLoS One. 2013;8(3):e58106. doi: 10.1371/journal.pone.0058106. Epub 2013 Mar 5.
Staab, J. P., et al. (2017). "Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Barany Society." J Vestib Res 27(4): 191-208.
Stewart WF, Lipton RB, Dowson AJ et al, “Development and testing of the migraine disability assessment (MIDAS) questionnaire to assess headache-related disability,” Neurology 2001;56[Suppl. 1]:S20-S28)
Staab, J. P., et al. (2017). "Diagnostic criteria for persistent postural-perceptual dizziness (MdDS): Consensus document of the committee for the Classification of Vestibular Disorders of the Barany Society." J Vestib Res 27(4): 191-208.
Tinetti ME, Richman D and Powell L (1990). "Falls efficacy as a measure of fear of falling." Journal of Gerontology 45(6): 239-43.
Whitney, S. L., M. T. Hudak, et al. (1999). "The activities-specific balance confidence scale and the dizziness handicap inventory: a comparison." J Vestib Res 9(4): 253-9.