Staab, Jeffrey

Abstract Background Persistent postural‐perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities. Objective To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment. Design Retrospective cohort study. Setting Electronic medical records from a tertiary care center. Participants Patients ≥18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit. Interventions Not applicable. Main Outcome Measure(s) Patients' best clinical global impression‐improvement scale (CGI‐I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI‐I scores of 1 or 2 (indicating the patient was “very much” or “much” improved, respectively) considered treatment responders. Results In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post‐TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes ( p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI‐induced PPPD had a significantly worse mean CGI‐I score (2.49 ± 1.1) when compared to prior literature (1.71 ± 0.83) ( p < .001). Conclusions This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow‐up to assess treatment efficacy.

Purpose: This study aimed to describe the relationship between changes in pre and post self-perceived dizziness handicap, scores on the patient health questionnaire, and perceptions of patient's value of being evaluated and managed by a multidisciplinary team. Method: Seventy-eight patients completed the Dizziness Handicap Inventory (DHI) and Patient Health Questionnaire–Fourth Edition (PHQ-4) questionnaires post multidisciplinary clinical consultations and testing for the chief complaints of dizziness, unsteadiness, vertigo, or balance problems. The diagnoses of each patient were recorded from the clinical reports of each specialty consultation and were classified as structural, functional, or psychiatric. They were contacted by phone at least 6 months after their visit to obtain feedback regarding their symptoms and overall patient experience. Results: The change in DHI total score did not differ significantly by diagnosis ( p = .56), indicating that patients experienced an improvement in DHI total score regardless of diagnosis. PHQ-4 anxiety scores worsened by a mean of 0.7 points for those with structural diagnoses ( p = .04), improved by a mean of 0.7 points for psychiatric diagnoses ( p = .16), and improved by a mean of 0.3 points for functional diagnoses ( p = .39). Only seven patients would not recommend the team to a family or friend; these patients tended to report worsening DHI total scores ( p = .27) compared to the significant improvement in DHI total scores for patients who would make such a recommendation ( p < .001). Similarly, only 13 patients did not feel the information they received had a positive impact; these patients tended to report worsening DHI total scores ( p = .18) compared to the significant improvement in DHI total scores for patients who did feel the information had a positive impact ( p < .001). Discussion: The assessment and management of patients with chronic dizziness is challenging due to symptoms arising from multiple etiologies. Our finding of a vast difference between high satisfaction and relatively unchanged dizziness handicap suggests that there is value in seeing a multidisciplinary team where consultations are unhurried, care is coordinated, and expectations regarding treatment can be managed.