This article originally appeared in the Fall 2024 issue of On The Level.
Persistent postural-perceptual dizziness (PPPD) and Meniere’s disease (MD) are two distinct types of vestibular disorders that occur independently; however, they may also occur simultaneously. Diagnostic criteria exist to clearly define and classify vestibular disorders. An accurate diagnosis is key to provide appropriate treatment.
Persistent Postural-Perceptual Dizziness (PPPD)
PPPD is a chronic disorder in which patients may experience symptoms of dizziness, unsteadiness, and/or vertigo that occur consistently for up to three months or longer.
Symptom exacerbation results from upright posture, any type of movement, and/or visual stimuli. PPPD can be caused by other vestibular disorders, such as MD.
Meniere’s Disease (MD)
MD is characterized by episodic vertigo or dizziness, accompanied with hearing loss and fluctuating symptoms of tinnitus and/or ear fullness.
Symptoms normally occur for 20 minutes to 12 hours. Few symptoms, if any, exist during intermittent periods or after patients recover.
PPPD With MD
It is evident that these disorders have distinguishing features, different pathologies, and different prognoses; therefore, treatment will vary.
This study set out to highlight the significance of diagnosing PPPD as it occurs with MD, so as to treat patients for both simultaneously, and then to compare the clinical features of each disorder.
Study Overview
235 patients were enrolled in this study; 130 of these patients were diagnosed with MD and 105 of these patients were diagnosed with PPPD. 12 of the PPPD patients demonstrated MD as well. The methods utilized in this study included vestibular function tests and clinical symptom scales.
Objective Vestibular Function Tests
The vestibular function tests are objective measures tested by the examiner that reveal specific vestibular deficits for the purpose of obtaining an accurate diagnosis. The tests utilized in this study are:
- Bithermal air caloric testing
- Cervical and ocular vestibular–evoked myogenic potential testing (cVEMP and oVEMP)
- Rotary chair testing
- Posturography
Subjective Clinical Symptom Scales
In contrast to objective testing, the vestibular clinical symptoms scales are subjectively rated by the patient. The purpose of these scales is to gain insight into symptoms experienced, extent of symptoms, and impact on quality of life. These scales included:
- Dizziness Handicap Inventory (DHI)
- Niigata PPPD Questionnaire
- Hospital Anxiety and Depression Scale (HADS)
- The clinical symptom scales were also used to compare 23 patients with PPPD coexisting with MD and those with MD independently.
Study Results
The results of the study demonstrate that the vestibular function test scores were higher in patients with MD.
In contrast, the clinical symptoms scales were higher in patients with PPPD. Further more, these scores were even higher in patients with PPPD occurring simultaneously with MD than in those with MD alone.
This means that patients experiencing PPPD and PPPD with MD experience greater symptoms and a greater decrease in quality of life while MD patients demonstrated more objective vestibular deficits.
Conclusion
The results of this study confirm that it is necessary to utilize clinical symptom scales in addition to objective vestibular tests to determine the extent of symptoms and overlapping diagnoses. This information is invaluable to provide appropriate treatment for the best outcomes in prognosis and care.
Summary by Denise Schneider, DPT, FAAOMPT