Questionnaires for OtoNeurology

Timothy C. Hain, MD Page last modified: July 7, 2019 Return to testing index

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. While using the names of these instruments often sounds impressive, when you look at them carefully, you will see that these are often composed of very simple questions/answers. In our opinion, thats OK, but we think it is pretentious to use the names of these simple lists of questions as if they were magical incantations. We prefer functional names (such as the ABC) to instruments named after their authors.

Caveats:

None of the questionaires or surveys below 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 as well.

The difficulty here lies in diagnoses that are all symptoms. For example, lets take migraine. This is a diagnosis based on what a patient tells you - -symptoms. It is not based on a blood test, a genetic test, or a brain image. One should not confuse a collection of symptoms with having a pattern that some committee has decided is a diagnosis.

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. This tendency to make causal inferences from symptom inventories is illogical, and common.

Infrastructure and logistics

Ideally, one would like to administer diagnostic questionnaires to establish diagnoses (once), and symptom questionnaires to establish progress (every visit). We are presently building a survey infrastructure to do this. We have already given a lot of these surveys to many people (see bottom).

Below are some of the questionnaires that we have found useful.

See also separate pages on cognitive and headache questionnaires.

Questionnaire used to quantify balance dysfunction Link to questionnaire Source
Activities specific Balance Confidence Scale (ABC) ABC (online version: ) Powell and Meyers, 1995; Whitney et al, 1999
Berg Balance Scale. This is commonly used.

http://www.aahf.info/pdf/Berg_Balance_Scale.pdf

http://www.strokecenter.org/trials/scales/berg.html

Berg et al, 1989.
Chambliss Mobility Survey CMS http://www.psych.upenn.edu/~dchamb/questionnaires/index.html
Dizziness Handicap Inventory. The DHI is commonly used.

DHI itself (online version)

Another online version:

Jacobson and Newman, 1990, and several others below.

See many "apps" for smartphones, for hearing.

 

 

Hearing questionnaire (NIH version) HQ http://www.nidcd.nih.gov/health/hearing/10ways.asp
Falls efficacy scale. FES, online version: Tinetti, Richman et al. 1990
Modified falls efficacy scale (MFES) MFES Hill, Schwartz and others, 1996
Medical outcomes study short form 36 (SF-36). The link provides a public-domain source for this questionnaire. A local copy of it is here. SF-36

Enloe and Sheilds, 1997.

http://www.rand.org/health/surveys_tools/mos/mos_core_36item.html

Tinnitus Handicap Inventory/Questionnaire THI (pdf) buttonOnline buttonTHI description Comment: This is not a diagnostic test. It is a measure of distress.
Vestibular Activities of Daily Living. We don't know of anyone using this.   Cohen et al, 2000

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.

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" thinks they are 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:

References