A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers

Abstract

Objective/Hypothesis To assess for semantic differences regarding the definition of dizziness among otolaryngology patients, otolaryngologists, and non‐otolaryngologist providers. Study Design Cross‐sectional survey. Methods Between March and May 2020, a survey consisting of 20 common descriptors for dizziness within five domains (lightheadedness, motion sensitivity, imbalance, vision complaints, and pain) was completed by patients at two outpatient otolaryngology clinics. Surveys were subsequently obtained from otolaryngology and non‐otolaryngology providers attending a multidisciplinary dizziness lecture. The primary outcome measure was to assess for differences in definition of dizziness between patients and providers. Secondary outcome measures included assessing differences between otolaryngologists and non‐otolaryngologists. Results About 221 patients and 100 providers participated. Patients selected a median of 7 terms compared to 8 for providers (P = .375), although providers had a larger overall distribution of number of terms selected (P = .038). Patients were more likely than providers to define dizziness according to the following domains: lightheadedness (difference 15.0%; 95% confidence interval [CI] 5.5%–25.3%), vision complaints (difference 21.6%, 95% CI 12.0%–29.6%), and pain (difference 11.5%, 95% CI 4.7%–17.1%). Providers were more likely to define dizziness according to the motion sensitivity domain (difference 13.8%, 95% CI 6.8%–19.6%). Otolaryngology and non‐otolaryngology providers defined dizziness similarly across symptom domains. Conclusion Although patients and providers both view dizziness as imbalance, patients more commonly describe dizziness in the context of lightheadedness, vision complaints, and pain, whereas providers more frequently define dizziness according to motion sensitivity. These semantic differences create an additional barrier to effective patient‐provider communication. Level of Evidence 4. Laryngoscope, 131:E1443–E1449, 2021

Prevalence and distribution of musculoskeletal pain in patients with dizziness—A systematic review

“…Dizziness is a complaint with several potential etiologies, such as cardiovascular and neurological diseases, psychiatric disorders, metabolic disorders, infections, side effects from medications and vestibular disorders. It is a symptom often described as a feeling of vertigo, motion sensitivity, lightheadedness/presyncope, or disequilibrium/imbalance (Sloane et al., 2001 ; Sommerfeldt et al., 2021 ). In most cases dizziness passes quickly, but in 30%–50% of the cases the symptoms become persistent (Cousins et al., 2017 ; Godemann et al., 2005 ; Heinrichs et al., 2007 ; Kammerlind et al., 2005 ).…”

The hermeneutics of symptoms

“…Havi Carel and Gita Györffy narrate the case of a 5-year old girl whose clinicians go on a wild goose chase for the causes of ‘double vision’, because they fail to interpret accurately her description of ‘blurred vision’ (Carel and Györffy 2014 ). Descriptions of ‘dizziness’ are notorious amongst clinicians for being difficult to interpret appropriately – and even clinicians most experienced in managing ‘dizziness’, fully aware of this difficulty, still systematically misread them (Sommerfeldt et al 2021 ).…”

What do we mean when we have a “sinus infection?”

“…However, semantic content in the interpretation and expectation of sinus infection symptoms may be variable. Previously, other common ear, nose, and throat complaints such as congestion 9 and dizziness 10 have shown significant differences between patients and providers, though these studies did not consider regional and geographic differences.…”