simple tool dizziness diagnosis

A Simple, Quick, and Effective Tool to Help Diagnosis Dizziness and Vertigo

As we and many others have discussed in previous blogs and articles, the word “dizzy” is a broad and ineffective descriptor of symptoms that might bring someone to a vestibular clinic. I did an eight part series on this topic about ten years ago.

It is important to get additional information to venture any guess as to the possible cause of the complaint of “dizziness.” We know that patients are generally poor at describing the quality of the dizziness (Is it vertigo? Or lightheadedness? Or disequilibrium?), but they are better at reporting timing (duration of episodes) and triggers (Positional? Postural? Spontaneous?). Unfortunately, if you ask the patient to describe their dizziness, they will likely include considerable non-relevant information (e.g., “I was at my sisters and we had just finished doing the dishes, etc”).

It is fine to listen politely and patiently for key phrases that might provide some clarity about timing and triggers, but in a busy practice you may want to condense this description to only relevant information. That is the basis for the Short Form Questionnaire (SFQ) attached below.

The SFQ is an eight item list providing clear, but concise, one sentence descriptions of symptom quality, timing and triggers of the most common disorders seen in a vestibular clinic. This form takes about two minutes to complete and just a few seconds to review.

I created the SFQ to use in my private practice years ago, and now that I am in a university medical center setting, we decided to validate the SFQ in our particular patient setting. Validation included comparing final diagnosis after full history interview and comprehensive vestibular evaluation to suspected diagnosis based on the SFQ. 

 

How to Use the SFQ?

 

The patient is asked to carefully read each descriptor, and choose the ONE that best describes their symptoms. We allow them to cross out or add a word if it clarifies the description. This is completed before the patient is seen by the examiner. We have found that 92% of people can follow these instructions without additional direction.

 

What have We Learned?

 

The SFQ is more applicable to a primary care setting or community ENT/Audiology setting. In a community ENT setting, the SFQ was able to predict the final diagnosis with about 70% accuracy.

In the university medical center setting, where we see more complicated patients, often with multiple issues, it was found to be 62% predictive of final diagnosis. We did both with the SFQ blinded and unblinded to the examiner, with no significant difference in predictive ability.

 

Summary

 

There are other questionnaires that have higher predictive values, but they are considerably longer requiring valuable time. In the primary care setting, there may be value to a short questionnaire that allows accurate categorization of the majority of dizzy patients in the least amount of time (click below for downloadable PDF).

Click to enlarge

There is an accompanying guide for practitioners that may not be familiar with the pathologies associated with these complaints. 

The below guide directs the practitioner to the appropriate page in the Practitioner Guide to the Dizzy Patient, which can be downloaded from the link. These pages provide additional information about the suspected pathology.

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.

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