The Dizziness Handicap Inventry ( DHI ) P1. Des lking up increase yur prblem? Yes E2. Because f yur prblem, d yu feel frustrated? Yes F3. Because f yur prblem, d yu restrict yur travel fr business r recreatin? Yes P4. Des walking dwn the aisle f a supermarket increase yur prblems? Yes F5. Because f yur prblem, d yu have difficulty getting int r ut f bed? Yes F6. Des yur prblem significantly restrict yur participatin in scial activities, such as Yes ging ut t dinner, ging t the mvies, dancing, r ging t parties? F7. Because f yur prblem, d yu have difficulty reading? Yes P8. Des perfrming mre ambitius activities such as sprts, dancing, husehld Yes chres (sweeping r putting dishes away) increase yur prblems? E9. Because f yur prblem, are yu afraid t leave yur hme withut having withut Yes having smene accmpany yu? E10. Because f yur prblem have yu been embarrassed in frnt f thers? Yes P11. D quick mvements f yur head increase yur prblem? Yes F12. Because f yur prblem, d yu avid heights? Yes P13. Des turning ver in bed increase yur prblem? Yes F14. Because f yur prblem, is it difficult fr yu t d strenuus hmewrk r yard Yes wrk? E15. Because f yur prblem, are yu afraid peple may think yu are intxicated? Yes F16. Because f yur prblem, is it difficult fr yu t g fr a walk by yurself? Yes P17. Des walking dwn a sidewalk increase yur prblem? Yes E18.Because f yur prblem, is it difficult fr yu t cncentrate Yes F19. Because f yur prblem, is it difficult fr yu t walk arund yur huse in the dark? Yes Smetimes N
E20. Because f yur prblem, are yu afraid t stay hme alne? Yes E21. Because f yur prblem, d yu feel handicapped? Yes E22. Has the prblem placed stress n yur relatinships with members f yur family Yes r friends? Yes E23. Because f yur prblem, are yu depressed? F24. Des yur prblem interfere with yur jb r husehld respnsibilities? Yes P25. Des bending ver increase yur prblem? Yes Used with permissin frm GP Jacbsn. Jacbsn GP, Newman CW: The develpment f the Dizziness Handicap Inventry. Arch Otlaryngl Head Neck Surg 1990;116: 424-427 DHI Scring Instructins The patient is asked t answer each questin as it pertains t dizziness r unsteadiness prblems, specifically cnsidering their cnditin during the last mnth. Questins are designed t incrprate functinal (F), physical (P), and emtinal (E) impacts n disability. T each item, the fllwing scres can be assigned: N=0 Smetimes=2 Yes=4 Scres: Scres greater than 10 pints shuld be referred t balance specialists fr further evaluatin. 16-34 Pints (mild handicap) 36-52 Pints (mderate handicap) 54+ Pints (severe handicap)
Vestibular Questinnaire: Patient: Date: Characterize yur dizziness: 1. Light-headedness, faintness, giddiness. 2. Unsteadiness, imbalance 3. Objects are spinning arund yu and yu are still. 4. Yu are spinning arund and bjects arund yu are still. 5. Yu blackut r lse cnsciusness 6. Tendency t fall. Please circle the directin (s) Right Left Frward Backward 7. Lss f balance when walking. If yu als veer r feel pulled t ne side r ther indicatin the directin: T the left T the right 8. My dizziness is cnstant. 9. My dizziness cmes in attacks/spells. 10. My dizziness cmes n suddenly. 11. I have n dizziness r imbalance between episdes. 12. I can tell when an episde is abut t start by: Hw: 13. Date f my first dizzy spell: 14. Date f my mst recent episde: 15. On average, hw ften des yu dizziness happen: Exacerbating and Remitting Factrs: 16. Turning my head left/right makes dizziness start r wrsen. 17. Lying dwn r sitting up brings n my dizziness.
-2-18. Standing up brings n my dizziness. 19. Walking in the dark is especially difficult 20. There is a relatinship between my dizziness and tensin, stress r anxiety in my life. Explain: 21. Des anything make yur dizziness better? What: Assciated Symptms 22. Nausea r vmiting? 23. Sweating? 24. Deafness r difficulty hearing? 25. Nises in ear (buzzing, ringing, raring) 26. Change in the nise in ear when dizzy? 27. Fullness r pain in ears? 28. Drainage frm ears? 29. Headache r pressure in head with dizziness? During After Where? Migraine Headaches? If yes hw ften? 30. Duble visin, blurred visin, blindness? 31. Weakness r clumsiness in arms/legs? 32. Difficulty with speech r swallwing? 33. Neck r back pain? 34. Depressin r anxiety? Predispsing Factrs: 35. Head Injury cncussin, skull fracture, kncked uncnscius?
-3-36. Whiplash r neck pain? 37. Eye disrder r eye surgery? 38. Ear infectins r ther ear disease? 39. Did yu begin taking prescriptin r nnprescriptin medicatin regularly befre yur dizziness started? If s what? 40. Drink Alchl: per day: years: Patient: Date: