Translation and validation of the dizziness handicap inventory in Greek language

Objective: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI). Design: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach’s alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman’s correlation coefficient. Test–retest reliability was tested using ICC (Intraclass Correlation Coefficient). Sample size: Ninety (90) patients were included in the study. Results: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r?=??0.472; p?r₁?=??0.342; p₁?=?0.001, DHI-F r₂?=??0.448 p₂?r₃?=??0.472 p₃?Conclusion: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.     

The dizziness handicap inventory and its relationship with functional balance performance.

OBJECTIVE: The purpose of this study was to describe the relation between the Dizziness Handicap Inventory (DHI) and balance performance measures. STUDY DESIGN: Retrospective case series. SETTING: Outpatient balance clinic in a tertiary referral center. PATIENTS: Patients referred with dizziness or imbalance of vestibular and nonvestibular origin. OUTCOME MEASURES: DHI, Romberg with Jendrassik maneuver, standing on foam, tandem Romberg, single-leg stance, the timed up and go test, the Dynamic Gait Index (DGI), tandem gait, and the 10-m walking test. RESULTS: The mean age of participants (n = 214) was 53.9 years. The mean DHI total score was 35.1, ranging from 0 to 96. Spearman rank correlation coefficients (rS) between DHI and the static balance tests were fair and ranged between -0.42 (p < 0.01) for single-leg stance with eyes closed and -0.51 (p < 0.01) for single-leg stance with eyes open. Only the Romberg test with Jendrassik maneuver correlated weakly (rS = -0.25; p < 0.01) with the DHI. Correlations with the walking tests were moderate, the connection with the DGI being the strongest one (rS = -0.69; p < 0.01). Forty-two percent of the variance in DHI scores in our patients was accounted for by the DGI score (r = 0.417). CONCLUSION: Functional balance tests involving locomotion correlate better with DHI scores when compared with static balance measures. The DGI explains a large component of handicap in dizzy and unsteady patients, which advocates its use in these patients.     

Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo.

OBJECTIVE: The purpose of the study was to determine whether a newly developed subscale of the Dizziness Handicap Inventory (DHI) could assist in the screening of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Retrospective case review. SETTING: Tertiary balance referral center. PATIENTS: Charts of 383 patients (mean age, 61 yr) with a variety of vestibular diagnoses (peripheral and central) were reviewed. INTERVENTIONS: Patients completed the DHI before the onset of physical therapy intervention. MAIN OUTCOME MEASURES: A newly developed BPPV subscale developed from current DHI items was computed to determine whether the score could assist the practitioner in identifying individuals with BPPV. RESULTS: Individuals with BPPV had significantly higher mean scores on the newly developed BPPV subscale of the DHI (p < 0.01). The five-item BPPV score was a significant predictor of the likelihood of having BPPV (chi2 = 8.35; p < 0.01). On the two-item BPPV scale, individuals who had a score of 8 of 8 were 4.3 times more likely to have BPPV compared with individuals who had a score of 0. CONCLUSION: Items on the DHI appear to be helpful in determining the likelihood of an individual having the diagnosis of BPPV.     

慢性头晕患者的颈肌张力和静态平衡的客观评价

目的:头晕患者常诉有颈部僵硬的症状。本研究拟探讨颈部症状在头晕患者中的病理机制。方法:26例因单侧前庭病变导致慢性头晕的患者和24例健康对照者参与本次研究,通过客观测量慢性头晕患者双侧斜方肌的肌张力,探讨其与静态姿势干扰的关系。采用颈肌张力仪客观测量双侧斜方肌张力,计算双侧颈肌张力(ANT)和双侧颈肌张力比值(右/左)(RNT)。静态平衡仪测量重心移动轨迹的总长度(LNG)。结果:头晕患者闭眼状态下,ANT和LNG呈负相关(r=-0.44,P<0.05)。头晕患者和健康对照者在闭眼状态时,RNT和LNG呈正相关。结论:ANT平均值升高提示前庭代偿导致的维持静态姿势平衡的颈肌张力增加。颈肌张力的不对称和姿势不平衡有关。     

Some experiences with hearing disability/handicap and quality of life measures

To achieve detailed information on the outcome of hearing rehabilitation in a clinical setting, measurements of hearing disability and hearing handicap have been introduced, and the present study describes the preliminary experiences with these measures in a series of hearing-impaired subjects referred for audiological evaluation. To outline hearing disability/hearing handicap (HD/HH), before continuation or initiation of treatment, the Gothenburg profile and a generic health-related quality of life--the SF-36 questionnaire--were used to evaluate any adverse effects resulting from hearing disorders. The Gothenburg profile and the SF-36 questionnaire were mailed to 634 subjects appointed for audiological examination with a request to complete the questionnaires at home. Three questions were enclosed concerning the capacity to complete the questionnaires, showing that 1.9 per cent were incapable of completing them, 17.5 per cent needed assistance, 43.5 per cent completed the questionnaires, and 37.1 per cent did not respond to them. Thus the response rate was only 55.5 per cent and, in addition, these responses were characterised by missing data. An arbitrary criterion of an average score per question of >3 for the averaged HD and HH items respectively was applied, resulting in 72.7 per cent indicating HD, whereas 30.3 per cent indicated HH according to the items in the profile. Significant differences in hearing levels were found between those experiencing HD and HH having a score >3 and those with a score <3. When analysing the general health status, general perception of health and social functioning, significantly lower scores were found for those experiencing HD/HH, whereas no significant differences were found between the total sample of hearing-impaired subjects and the age-matched population for these parameters. It is concluded that the present procedure cannot be implemented as a routine outcome measure in a clinical setting and alternative outcome measures should be considered.     

Double-blind,randomized, multicenter study comparing the effect of betahistine and flunarizine on the dizziness handicap in patients with recurrent vestibular vertigo

OBJECTIVE: The aim of this double-blind, randomized, multicenter study was to compare the efficacy of betahistine dihydrochloride (BH) and flunarizine (FL) using the Dizziness Handicap Inventory (DHI), a validated self-assessment questionnaire that has not previously been used in a clinical trial to evaluate antivertigo drugs. MATERIAL AND METHODS: Patients with recurrent vertigo of peripheral vestibular origin and who were severely handicapped by vertigo were randomized to an 8-week course of treatment with oral BH 48 mg daily or oral FL 10 mg daily. The efficacy endpoints were the total DHI score and the physical, functional and emotional subscores. RESULTS: Fifty-two patients completed the study. After 8 weeks of treatment the mean total DHI score and the physical subscore were significantly lower in the BH group compared to the FL group (7.5 and 3.6 points, respectively). The mean total DHI score as well as the three subscores decreased significantly after 4 and 8 weeks in both treatment groups. CONCLUSION: This study showed that at 8 weeks BH is significantly more effective than FL in terms of improving the total DHI score and the physical subscore. It was also established that the DHI is a useful and reliable method for evaluating the efficacy of antivertigo drugs.     

The influence of headaches in patients with chronic dizziness

Conclusion: The frequency of headaches in patients complaining of chronic dizziness is closely related to the severity of the dizziness impairments and mood states, such as anxiety. It is, therefore, important to treat co-morbid headache in patients with chronic dizziness. The severity of the dizziness impairments and other mood states, including anxiety, did not differ between patients with migraine or non-migraine headaches. Objectives: Patients with chronic dizziness often complain of headaches or general fatigue. This study investigated the influence of the frequency of headaches on dizziness impairments, anxiety, quality-of-life, and other mood states in patients with chronic dizziness. Method: The subjects consisted of 100 consecutive patients with intractable dizziness. Several types of questionnaires were used in the investigations. Results: Of the 85 patients, 51 had either type of headache (tension headache, 38; migraine, 13). The total score on the Dizziness Handicap Inventory correlated linearly with general fatigue (R = 0.39, p < 0.001) and headache (R = 0.25, p < 0.05). The patients with any type of headache had a significantly more positive family history of headache (p < 0.05).     

少年儿童慢性鼻窦炎患者生活质量量表的编制和检验

目的编制一个评价少年儿童慢性鼻寞炎患者（简称患儿）生活质量的多维测评量表。方法参考国内外生活质量量表,构成患儿生活质量初始量表,对52例患儿进行生活质量的预测试后,进行条目筛选,建立量表,并对量表作信度和效度检验。结果编制的少年儿童慢性鼻寞炎患者生活质量量表（简称量表）分疾病症状、普适性生活质量以及视觉模拟评分3个部分,16个条目。量表的重测信度为0．989,分半信度为0．776,克朗巴赫α系数为0．751。与WHOQOL-BREF总分的Pearson相关系数为0．672,P＜0．01：经因子分析获得的因子结构与量表设计的预想结构一致,具有较好结构效度。量表的信度和效度符合心理测量学要求。结论编制的量表是可信、有效和敏感的,可应用于临床。     

Voice handicap evaluation of patients with pathologic sulcus vocalis

OBJECTIVES: The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). METHODS: The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. RESULTS: The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. CONCLUSIONS: These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.     

The effect of sleep disturbance in patients with chronic dizziness

Conclusions: The comorbidity of sleep disturbance with chronic dizziness in women was related to the intensity of distress and interference with their lives due to dizziness, although it was not related to objective variables of dizziness. In addition, the presence of sleep disturbance was associated with severe anxiety and depression, and low health-related quality-of-life (QoL).

Objectives: This study investigated the effect of sleep disturbance in patients with chronic dizziness on symptoms of dizziness, handicaps due to dizziness, health-related QoL, and emotional distress.

Method: The participants of this study were 252 in-patients with chronic dizziness. Participants completed questionnaires containing the Dizziness Handicap Inventory (DHI, three sub-scales: Physical [DHI-P], Emotional [DHI-E], and Functional [DHI-F] scores), Pittsburgh sleep quality index (PSQI-J), Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study 8-items Short Form Health Survey (SF-8, health-related QoL). The participants then underwent gravity center fluctuation measurement as an objective indicator of the severity of dizziness.

Results: The prevalence of sleep disturbance (PSQI-J global score ≧6) was 65.1% in these participants. Two-way ANOVA of the DHI scores showed significant interaction between sleep disturbance and sex in DHI total, DHI-E score, and DHI-F score, indicating that these scores were higher in women with sleep disturbance. Regarding DHI-P score, only the main effect of sex was significant (women?>?men). Sleep disturbance had no significant effect on objective indicators of severity of dizziness. Patients with sleep disturbance had significantly higher HADS scored and a lower SF-8 scored than patients without sleep disturbance.     

Tinnitus evaluation: relationship between pitch matching and loudness,visual analog scale and tinnitus handicap inventory

IntroductionTinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching.ObjectiveTo analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching.MethodsThe study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.ResultsRegarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant.ConclusionThere was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.     

Mental health and quality of life in patients with chronic otitis media

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient’s other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p < 0.001), interpersonal sensitivity (p < 0.001), depression (p < 0.001), phobic anxiety (p < 0.001), and other subscores, and also global severity index score (p < 0.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (p < 0.001), general health perception (p < 0.004), social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.     

Impact of gender, age, and comorbidities on quality of life in patients with chronic rhinosinusitis

STATEMENT OF THE PROBLEM: To evaluate the impact of gender, age and comorbidities of health-related quality of life (HR-QOL) assessments in patients with chronic rhinosinusitis. METHODS: The prospective administration of the German Adapted Version of the Sino-Nasal Outcome Test 20 (SNOT-20 GAV) to patients with chronic rhinosinusitis. Two hundred and two patients with chronic rhinosinusitis filled out the questionnaire before functional endoscopic sinus surgery (FESS) and again at the 3-month follow-up. MAIN RESULTS: Gender had a significant impact on the Overall Score (OS) and on the General Quality of Life Score (GQOL) of the SNOT-20 GAV but no influence on the disease-specific scores of 'Primary Nasal Symptoms' (PNS) and 'Secondary Rhinogenous Symptoms' (SRS). Age did not influence HR-QOL. Patients with comorbidities demonstrated lower HR-QOL scores. PRINCIPAL CONCLUSION: Women had significantly poorer QOL scores than men. It seems that the influence of gender reflects general HR-QOL views rather than illness-related expectations.