{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:48:22Z","timestamp":1790189302216,"version":"4.1.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Two hundred thirty-one patients with chronic vestibular syndromes lasting for &amp;gt;3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests\/questionnaires\/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity\/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%\/CUSs for UVH and HADS-A score\/age for CDA showed an overall diagnostic accuracy of 72.8%.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.<\/jats:p>","DOI":"10.3389\/fneur.2021.768718","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:52:38Z","timestamp":1637225558000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes"],"prefix":"10.3389","volume":"12","author":[{"given":"Meiko","family":"Kitazawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Morita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chihiro","family":"Yagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuniyuki","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Ohshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Yamagishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Izumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izumi","family":"Koizuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arata","family":"Horii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.ncl.2015.04.010","article-title":"Overview of the international classification of vestibular disorders","volume":"33","author":"Bisdorff","year":"2015","journal-title":"Neurol Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3233\/VES-170622","article-title":"Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee","volume":"27","author":"Staab","year":"2017","journal-title":"J Vestib Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3233\/VES-170619","article-title":"Bilateral vestibulopathy: diagnostic criteria consensus document of the Classification Committee of the B\u00e1r\u00e1ny Society","volume":"27","author":"Strupp","year":"2017","journal-title":"J Vestib Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3233\/VES-190672","article-title":"Presbyvestibulopathy: diagnostic criteria consensus document of the Classification Committee of the Barany Society","volume":"29","author":"Agrawala","year":"2019","journal-title":"J Vestib Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s00415-020-10139-4","article-title":"Diagnosing vestibular hypofunction: an update","volume":"268","author":"Starkov","year":"2021","journal-title":"J Neurol."},{"key":"B6","first-page":"65","article-title":"Clinical nystamography; a detailed study of electro-nystamography in 341 patients with vertigo","volume":"24","author":"Jongkees","year":"1962","journal-title":"Pract Otorhinolaryngol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"817","DOI":"10.3109\/00016489.2011.565423","article-title":"The Japanese version of the dizziness handicap inventory as an index of treatment success; exploratory factor analysis","volume":"131","author":"Goto","year":"2011","journal-title":"Acta Otolaryngol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1001\/archotol.1990.01870040046011","article-title":"The development of the dizziness handicap inventory","volume":"116","author":"Jacobson","year":"1990","journal-title":"Arch Otolaryngol Head Neck Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e747","DOI":"10.1097\/MAO.0000000000002325","article-title":"A validated questionnaire to assess the severity of persistent postural-perceptual dizziness (PPPD): the Niigata PPPD questionnaire (NPQ)","volume":"40","author":"Yagi","year":"2019","journal-title":"Otol Neurotol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1007\/s11940-018-0535-0","article-title":"Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders","volume":"20","author":"Popkirov","year":"2018","journal-title":"Curr Treat Options Neurol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/0003489418823017","article-title":"Vestibular rehabilitation therapy outcomes in patients with persistent postural-perceptual dizziness","volume":"128","author":"Nada","year":"2019","journal-title":"Ann Otol Rhinol Laryngol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e01864","DOI":"10.1002\/brb3.1864","article-title":"Multimodal treatment of persistent postural-perceptual dizziness","volume":"10","author":"Axer","year":"2020","journal-title":"Brain Behav."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3504","DOI":"10.1161\/STROKEAHA.109.551234","article-title":"HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging","volume":"40","author":"Kattah","year":"2009","journal-title":"Stroke."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.768718\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:52:42Z","timestamp":1637225562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.768718\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":14,"alternative-id":["10.3389\/fneur.2021.768718"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2021.768718","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]},"article-number":"768718"}}