Training in VNG

Interpreting the Dizziness Handicap Inventory (DHI) and VRBQ

10 mins
04 April 2023


Updated by Leigh Martin on April 4, 2023

It’s a very positive step to use these questionnaires alongside the VNG tests to support your diagnosis, guide decision-making, and chart progress of patients.


What is the Dizziness Handicap Inventory (DHI)?

The DHI is a 25-question, self-administered questionnaire used to quickly capture the impact of dizziness. The three possible answers to the 25 questions are ‘Always’, ‘Sometimes’, or ‘No’. Always yields 4 points, sometimes yields 2 points, and no yields 0 points. Once completed, the questionnaire gives a total score from 0 to 100 points, which provides an indication of the handicapping effect of dizziness. A score of 0 is no effect, and a score of 100 is maximum effect.

The questions are also grouped into three domains:

  • Physical (P)
  • Emotional (E)
  • Functional (F)

Referring to the responses in each of these domains may help you to gauge the area of most handicap, and thus help to understand where you might place the emphasis in terms of rehabilitation strategies.

See Figure 1 for a complete overview of the DHI.


A table with 5 columns and 26 rows. The first column is the question number. The second column is the question. The third column is the answer ‘Always’. The fourth column is the answer ‘Sometimes’. The fifth column is the answer ‘No’. The 25 questions center around if specific movements cause problems, and if these problems cause people to feel certain emotions or refrain from certain activities. For example, question P1 is the following: Does looking up increase your problem? The follow-up questions to P1 are the following: Because of your problem, do you feel frustrated? Because of your problem, do you restrict your travel for business or pleasure?
Figure 1: Dizziness Handicap Inventory (DHI) self-administered questionnaire. Image source.


DHI score change needed to indicate a true change

If you’re using the DHI as an outcome measure to chart progress after a program of vestibular rehabilitation therapy, then you need a change of 18 points in the overall score to consider this a true change.

It’s important to note that the score someone provides on the DHI will not always relate closely with the evidence of peripheral vestibular dysfunction that is indicated by the vestibular test battery. For example, someone may have a high degree of handicap and negative impact on their quality of life, and yet have little or no apparent vestibular dysfunction.


What is the Vestibular Rehabilitation Benefit Questionnaire (VRBQ)?

Like the DHI, the VRBQ provides a snapshot of the overall status at the beginning of a treatment program, which might well be at the point of vestibular assessment. You can repeat it after a vestibular rehabilitation treatment program to assess any changes in the patient’s self-reported status.

The questionnaire has two halves. The first assesses the symptoms, with the responses broken down into three aspects related to:

  • Motion
  • Anxiety
  • Dizziness

The second half assesses the impact of dizziness upon quality of life. The scoring provides a percentage scale, where 0% is no deficit compared with the patient’s own normal state, and 100% is the maximum deficit. 


VRBQ score change needed to indicate a true change

You need a change of 7% in the overall score to consider this a true change. You need changes of 6% and 9% to consider these as true changes in the Symptoms and Quality of Life halves, respectively.


Further reading

[1] Jacobson, G.P. and Newman, C.W. (1990) The development of the dizziness handicap inventory. Archives of Otolaryngology Head Neck Surgery, 116 pages 424 - 427.

[2] Morris, A., Lutman, M., and Yardley, L. (2008) Measuring Outcome from Vestibular Rehabilitation, Part I: Qualitative development of a new self-report measure. International Journal of Audiology, 47 pages 169-77.

[3] Morris, A., Lutman, M., and Yardley, L. 2009. Measuring Outcome from Vestibular Rehabilitation, Part II: Refinement and validation of a new self-report measure. International Journal of Audiology, 48 pages 24-37.


Michael Maslin
After working for several years as an audiologist in the UK, Michael completed his Ph.D. in 2010 at The University of Manchester. The topic was plasticity of the human binaural auditory system. He then completed a 3-year post-doctoral research program that built directly on the underpinning work carried out during his Ph.D. In 2015, Michael joined the Interacoustics Academy, offering training and education in audiological and vestibular diagnostics worldwide. Michael now works for the University of Canterbury in Christchurch, New Zealand, exploring his research interests which include electrophysiological measurement of the central auditory system, and the development of clinical protocols and clinical techniques applied in areas such as paediatric audiology and vestibular assessment and management.

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