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Home >  Research News >  Patients with Persistent Postural-Perceptual Dizziness Show Warning Signs Early On

Patients with Persistent Postural-Perceptual Dizziness Show Warning Signs Early On

New study finds that patients with an onset of vestibular balance disorder symptoms show early signs of it getting worse

Release Summary

People who suffer from persistent postural-perceptual dizziness (PPPD) experience unsteadiness, non-spinning vertigo and dizziness. These symptoms are exacerbated by movement, upright posture, and visual stimuli. In a new study, scientists from Nagoya City University have tried to find out if these exacerbating factors are present in the period before PPPD is diagnosed. They found that patients developing PPPD are likely to have them early on after the onset of balance disorder symptoms.

Full text of release

The vestibular system, which is the link between the inner ear and the brain, helps the body maintain its balance. When people experience vestibular symptoms, i.e., symptoms of balance disorder, it can develop into persistent postural-perceptual dizziness (PPPD), a chronic disorder where patients experience dizziness and non-spinning vertigo, particularly during moving, maintaining an upright posture, and when exposed to complex visual stimuli. However, not all individuals suffering from vestibular symptoms go on to develop PPPD, and it is not clear if people showing exacerbating factors for PPPD tend to develop PPPD or not.

Recently, a research team comprising Assistant Professor Kayoko Kabaya, Dr. Masaki Kondo, Dr. Shinichi Iwasaki, and other researchers from Nagoya City University, Japan, analyzed medical records of patients who were tested for vestibular symptoms for the first time to identify predictive factors for developing PPPD later on, and explore the possibility that patients showing exacerbating factors early on are more likely to develop chronic PPPD following the onset of vestibular symptoms. “PPPD is often severe and resistant to treatment. We believe that it is important to provide preventive interventions before PPPD develops, and wanted to identify the characteristics of patients who are prone to PPPD,” explains Dr. Kabaya, the lead author of the study.

This paper was published in the journal Laryngoscope Investigative Otolaryngology

In their study, the severity of the symptoms experienced by the patients was evaluated using the Niigata PPPD Questionnaire (NPQ), which involved questions on the exacerbating factors (upright posture, movement, and visual stimulation). Additionally, the perception of handicap due to dizziness was evaluated using a self-assessment scale called “The Dizziness Handicap Inventory.” The patients were then followed up for more than 3 months, and the NPQ scores of patients developing PPPD during the follow-up were compared with that of patients who did not develop PPPD.

More than half of the patients reported experiencing exacerbating factors shortly after the vestibular symptoms, worsening their symptoms. About 10% of these patients developed PPPD during the follow-up period, and the exacerbating factors were found to have a more severe effect on the vestibular symptoms in these patients. Notably, the NPQ scores of those who developed PPPD were significantly higher than that of those who did not.

“Our results suggest that patients who develop PPPD are likely to have its exacerbating factors at the early stages of the disease following the onset of vestibular symptoms,” says Dr. Kabaya.

With these findings, the researchers are optimistic that their study could help establish preventive measures against the disease. “PPPD is a disease that causes long-term social loss and occurs following acute vestibular symptoms. Based on our finding that patients with exacerbating factors during acute vestibular symptom are more likely to develop PPPD, our study could encourage the development of intervention protocols for such patients before they develop PPPD,” says Dr. Kabaya.

We certainly hope her visions are realized soon!


DOI: 10.1002/lio2.735

About Dr. Kayoko Kabaya from Nagoya City University, Japan
Dr. Kayoko Kabaya is an Assistant Professor at the Department of Otolaryngology, Head and Neck Surgery at Nagoya City University Graduate School of Medical Sciences, Japan. Her research interests include vestibular function test, vestibular rehabilitation, tinnitus, PPPD, and chronic dizziness. She has published 32 papers so far and is a recipient of several research grants and projects. She has presented in over 100 conferences.

Funding information
The Ministry of Education, Culture, Sports, Science and Technology, Grant/Award Numbers: 17K11338, 18K09370, 20K11161

Niigata PPPD Questionnaire (NPQ) and Dizziness handicap inventory (DHI) scores of PPPD vs. non-PPPD (follow-up) patients

The box plots show that there was a clear difference between the NPQ and DHI scores of patients who developed PPPD and those who did not PPPD during the follow-up period, as measured by the researchers.

Title of original paper: Presence of exacerbating factors of persistent perceptual-postural dizziness in patients with vestibular symptoms at initial presentation
Journal Laryngoscope Investigative Otolaryngology
Original Source URL https://onlinelibrary.wiley.com/doi/10.1002/lio2.735