News Release

Patients with persistent postural-perceptual dizziness show warning signs early on

New study finds that patients with an onset of vestibular balance disorder symptoms show early signs of it getting worse

Peer-Reviewed Publication

Nagoya City University

Niigata PPPD Questionnaire (NPQ) and Dizziness handicap inventory (DHI) scores of PPPD vs. non-PPPD (follow-up) patients

image: The box plots show that there was a clear difference between the NPQ and DHI scores of patients who developed PPPD and those who did not PPPD during the follow-up period, as measured by the researchers. view more 

Credit: Kayoko Kabaya from NCU, Japan

The vestibular system, which is the link between the inner ear and the brain, helps the body maintain its balance. When people experience vestibular symptoms, i.e., symptoms of balance disorder, it can develop into persistent postural-perceptual dizziness (PPPD), a chronic disorder where patients experience dizziness and non-spinning vertigo, particularly during moving, maintaining an upright posture, and when exposed to complex visual stimuli. However, not all individuals suffering from vestibular symptoms go on to develop PPPD, and it is not clear if people showing exacerbating factors for PPPD tend to develop PPPD or not. 

Recently, a research team comprising Assistant Professor Kayoko Kabaya, Dr. Masaki Kondo, Dr. Shinichi Iwasaki, and other researchers from Nagoya City University, Japan, analyzed medical records of patients who were tested for vestibular symptoms for the first time to identify predictive factors for developing PPPD later on, and explore the possibility that patients showing exacerbating factors early on are more likely to develop chronic PPPD following the onset of vestibular symptoms. “PPPD is often severe and resistant to treatment. We believe that it is important to provide preventive interventions before PPPD develops, and wanted to identify the characteristics of patients who are prone to PPPD,” explains Dr. Kabaya, the lead author of the study. This paper was published in the journal Laryngoscope Investigative Otolaryngology.

In their study, the severity of the symptoms experienced by the patients was evaluated using the Niigata PPPD Questionnaire (NPQ), which involved questions on the exacerbating factors (upright posture, movement, and visual stimulation). Additionally, the perception of handicap due to dizziness was evaluated using a self-assessment scale called “The Dizziness Handicap Inventory.” The patients were then followed up for more than 3 months, and the NPQ scores of patients developing PPPD during the follow-up were compared with that of patients who did not develop PPPD. 

More than half of the patients reported experiencing exacerbating factors shortly after the vestibular symptoms, worsening their symptoms. About 10% of these patients developed PPPD during the follow-up period, and the exacerbating factors were found to have a more severe effect on the vestibular symptoms in these patients. Notably, the NPQ scores of those who developed PPPD were significantly higher than that of those who did not. 

“Our results suggest that patients who develop PPPD are likely to have its exacerbating factors at the early stages of the disease following the onset of vestibular symptoms,” says Dr. Kabaya. 

With these findings, the researchers are optimistic that their study could help establish preventive measures against the disease. “PPPD is a disease that causes long-term social loss and occurs following acute vestibular symptoms. Based on our finding that patients with exacerbating factors during acute vestibular symptom are more likely to develop PPPD, our study could encourage the development of intervention protocols for such patients before they develop PPPD,” says Dr. Kabaya. 

We certainly hope her visions are realized soon!


DOI: 10.1002/lio2.735

About Nagoya City University, Japan
Nagoya City University (NCU), a public university established in 1950, began with the Medical School and the Faculty of Pharmaceutical Sciences. Its origins, however, stretch back to the Nagoya School of Pharmacy, founded in 1884, and the Nagoya Municipal Women's Higher Medical School, founded in 1943. NCU has grown into an urban-style public university in the center of Nagoya, Japan, with around 4,000 students and 1,600 faculty members. In the last 60 years, NCU has graduated over 26,000 students. NCU continues to expand as an advanced education and research center to assist in the improvement of local health and welfare, as well as the development of the local economy and culture.


About Dr. Kayoko Kabaya from Nagoya City University, Japan
Dr. Kayoko Kabaya is an Assistant Professor at the Department of Otolaryngology, Head and Neck Surgery at Nagoya City University Graduate School of Medical Sciences, Japan. Her research interests include vestibular function test, vestibular rehabilitation, tinnitus, PPPD, and chronic dizziness. She has published 32 papers so far and is a recipient of several research grants and projects. She has presented in over 100 conferences.

Funding information

The Ministry of Education, Culture, Sports, Science and Technology, Grant/Award Numbers: 17K11338, 18K09370, 20K11161

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