Viability of the dizziness handicap inventory in the management of persistent postural perceptual dizziness

ABSTRACT Objectives: Persistent Postural Perceptual Dizziness (PPPD) is a recently classified functional vestibular disorder characterized by chronic dizziness and imbalance, often associated with anxiety and visual motion sensitivity.Objective of the study is to use the Dizziness Handicap Inventory (DHI) to assess the impact of PPPD on physical, emotional and functional domains. Materials and Methods: This prospective study was conducted at a tertiary Hospital in South India over one year. Eighty-seven adults (21–60 years) diagnosed with PPPD as per Bárány Society criteria were included. Baseline evaluation included clinical, neurological, and psychiatric assessments along with audiological tests to exclude other causes. Patients completed the DHI questionnaire before treatment initiation. All were managed with Duloxetine (20 mg/day), Propranolol (40 mg/day), Cognitive Behavioral Therapy (CBT), and vestibular rehabilitation exercises for 12 weeks. Post-treatment DHI scores were recorded. Data were analyzed using paired t-test with significance at P < 0.05. Results: Of 300 screened patients with dizziness, 87 (29%) had PPPD (Male:Female = 55:32). Mean baseline DHI was 52.74, which improved to 26.30 after treatment (50.13% reduction; P < 0.05). Physical domain showed the highest improvement (62.44%), followed by emotional (47.32%) and functional (43.13%) components. No major adverse effects or dropouts were reported. Discussion: Multimodal management, including pharmacotherapy and CBT, resulted in significant improvement across all DHI domains, with physical symptoms responding best. Functional limitations were the least improved, suggesting the need for prolonged therapy. Conclusion: DHI is a useful tool to quantify disability in PPPD. Combined pharmacological and behavioral interventions significantly improve quality of life in affected patients.