PP1508 - Deciphering Positional Symptom Clusters in Chronic Dizziness

The current study investigates symptom clusters in chronic dizziness sufferers using DizzyGuide, a triage questionnaire, disseminated through a vestibular disorder support group, garnering 791 valid participant responses. It identified 301 symptom cluster combinations, with "positional" clusters being most prevalent. The study delves into the patient-reported issues tied to the dominant symptom cluster, “positional,” through qualitative analysis. Physical symptoms, cognitive symptoms, triggers, emotions, temporal properties, and management were identified as related to the positional cluster by the qualitative results. Highlights include the significance of detailed patient histories, patient narratives in understanding chronic dizziness, and aims to improve patient-centered care.

Summary: Purpose: The purpose of this mixed methods design is to explore symptom cluster assignment and explain patient-reported problems associated with the most frequently assigned symptom cluster in a sample whose dizziness is commonly chronic in nature. A hybrid explanatory mixed methods design was implemented to examine the triage-decision questions, DizzyGuide, that was posted online in a vestibular disorders support group from June 2021 to November 2022.


Method: Quantitative methods were first employed, in which symptom cluster frequencies, demographics, and symptom chronicity are described. Following the completion of the questionnaire, participants were placed into a symptom cluster or combination of 11 symptom clusters. This allows for the possibility of 2,048, or 211, cluster combinations. The symptom clusters are as follows: Positional, Meniere’s, Visual, Migraine, Anxiety and Depression, Falls, Superior Canal Dehiscence, Persistent Dizziness, Degenerative Dizziness, Concussion, and Ear Pain. After identifying the most commonly assigned symptom cluster, Positional (n= 50), a qualitative analysis was conducted to identify emerging themes in symptom descriptions by the participants in this cluster. Participants were asked to identify and describe their “problem” in an open-ended response as well as provide any current diagnosis. Themes were first independently generated and then agreed upon by two authors (BH and EP) using grounded theory. The grounded theory approach allows encoders to identify and label common patterns of themes and categories among participant responses to derive meaning of their experience. Experiences and interpretations of the data were compared and further discussed to create mutually exclusive themes.


Results: Quantitative analysis identified a total of 301 symptom cluster combinations. Data of 791 participants were analyzed. The most common descriptives were found in the age group of 70 to 79,  were female, and with a median of 1,294 for days experiencing symptoms of dizziness. The most common symptom cluster assigned into “positional” with 50 participants. Of those 50, five major, mutually exclusive themes emerged from the data: (a) physical symptoms, (b) cognitive symptoms, (c) temporal information, (d) management and/or adaptation, and (e) emotions
Conclusion: This study is a first step in understanding how patient triage questionnaires can be used to explore and improve the diagnosis and management of chronic dizziness. Chronic dizziness can be very difficult to diagnose, not only for clinicians but also for triage questionnaires or AI algorithms. It is important for clinicians to use decision-making programs in conjunction with patient input as well as their own clinical judgment and experience. Despite numerous benefits of tests and medical imaging available, collecting a thorough and accurate case history is remains paramount for differentiating between multiple diagnoses, or when suspecting a multiplicity of overlapping diagnoses.