Patient Perspectives on Episodic Dizziness and a Hypothetical At-Home Diagnostic Tool

Abstract

Patients with frequent dizzy attacks will report dissatisfaction with current diagnostic tools and express interest in a wearable at-home dizzy attack monitor. Existing diagnostic approaches for recurrent dizziness are often inadequate, particularly for episodic events that occur outside clinical settings. This study aimed to evaluate patient perspectives on current diagnostic and treatment methods and assess interest in a proposed at-home dizzy attack monitoring device. A cross-sectional survey was administered to 250 adults with self-reported dizzy attacks between December 2021 and January 2022 via Survey Healthcare Global. The survey included expert-reviewed items covering attack frequency, diagnostic experiences, treatment satisfaction, and responses to a conceptual wearable monitor. Of the 250 participants (32% male, 68% female), 43% were dissatisfied with diagnostic tools and 44% with treatments. Dissatisfaction was highest among those experiencing weekly (47% diagnostic, 48% treatment) and daily (46% diagnostic, 54% treatment) attacks. Interest in the hypothetical wearable monitor was reported by 79% overall, increasing to 86% among weekly and 85% among daily attack groups. Patients with frequent dizzy attacks report significant dissatisfaction with current standards of care and show strong interest in novel technology that enables real-time, at-home capture of symptoms to support more accurate diagnosis.

Introduction

Dizziness is among the most prevalent complaints in primary care settings, affecting an estimated 15% to 20% of adults annually, as evidenced by large population-based studies.^1,2 Dizziness is a multifaceted symptom that incorporates a range of other symptoms, including disequilibrium, presyncope, lightheadedness, and vertigo. ³ For the purposes of this study, “dizziness” is used as a patient-reported term encompassing a broad range of sensations, including vertigo, imbalance, lightheadedness, and presyncope. While these symptoms are clinically distinct, they are frequently conflated in patient self-reporting and were therefore grouped under the term “dizzy attacks” throughout this survey. Experiencing a dizzy episode at some point in adult life is common, but for some, the problem is a recurrent issue. The 3 most prevalent causes of recurrent episodic dizziness are disorders of the vestibular system and include benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), and Meniere's disease (MD). ⁴ When combined, these 3 disease pathologies make up 50% of patients presenting to the clinic for dizziness.^5–8 Vestibular disorders have presented a unique challenge for diagnosing dizzy attacks due to the incompletely understood interconnectedness among the disorders.^9–11 For instance, VM symptoms are often exhibited in patients with MD and BPPV.^5,10,12 It has also been shown that patients with BPPV have an increased risk of developing VM and patients with VM have an increased risk of developing BPPV.^13,14 Given these overlaps, clinicians are advised to suspect the possibility of multiple coexisting diagnoses in complicated dizzy patients or those who do not improve with treatment targeted at a single disorder. ¹⁵

An additional challenge in diagnosing episodic dizziness is its spontaneous nature, with attacks occurring unpredictably. ¹⁶ Standard testing for vestibular disorders, such as videonystagmography and electronystagmography, must be conducted in a clinical setting.^17,18 This limitation makes it difficult to capture real-time data on dizzy attacks, as they rarely coincide with office visits. As a result of these challenges, a majority of patients with recurrent episodic dizziness have not been diagnosed or are misdiagnosed.^19,20 The delay in diagnosis along with extraneous imaging and vestibular testing has been suggested as a reason for the high cost burden of episodic vestibular dizziness, which totals an estimated US$60 billion annually in the United States. ²¹ Little research has examined patients’ perspectives on the diagnostic approach to dizziness. In a survey of 521 individuals with vestibular symptoms, To-Alemanji et al found that diagnostic pathways were often prolonged and inefficient, with more than half waiting ≥5 months for a diagnosis and only 20% perceiving it as accurate. ²² Complementing this, Smith et al's multistakeholder qualitative study showed that vestibular disorders substantially disrupt daily life and often lead to psychological distress, with patients expressing a need for more individualized and comprehensive approach. ²³ Exploring conceptual solutions such as at-home dizzy attack monitors for the early detection of recurrent episodic dizziness may help address gaps in care delivery. While no such device was tested in this study, we aimed to assess patient interest in the concept of a wearable monitor, presented hypothetically as a potential future tool for episodic symptom tracking and diagnosis. A parallel can be drawn with the introduction of the adhesive patch electrocardiograph for arrhythmia detection, which, compared to the traditional 24-h Holter monitor, has reduced cost, wear time, and improved patient experience. ²⁴ Such innovations could be similarly beneficial in managing patients with dizziness.

Therefore, given the complexities and challenges patients face with current diagnostic and treatment modalities for recurrent episodic dizziness, coupled with the potential for technological advancements in testing, our study aimed to: (1) explore patient perspectives on the current diagnostic workup and treatment of recurrent episodic dizziness and (2) assess receptivity to the hypothetical use of a wearable at-home dizzy attack monitor as a future clinical adjunct.

Materials and Methods

Study Design and Participants

For the purposes of this study, “dizzy attacks” were referred to self-reported episodes of vertigo, imbalance, lightheadedness, presyncope, or other related sensations, as interpreted by each participant. This inclusive definition was used to reflect the variability and subjectivity of dizziness as reported by patients. This study received Institutional Review Board approval. A cross-sectional survey was conducted with 250 participants between December 2021 and January 2022. Recruitment was conducted using Survey Healthcare Global (SHG), an established online healthcare research database that maintains large panels of adults in the United States who consent to participate in health-related surveys. SHG employs stratified outreach and eligibility screening to ensure data integrity, drawing respondents through verified email invitations and partner networks. Participants were informed that the survey aimed to better understand their experience with recurrent dizziness. To be included in the study, participants had to be 18 years or older and have a self-reported history of dizzy attacks. Respondents who affirmed this screening item (“Do you ever experience dizzy attacks?”) were permitted to complete the full survey. Detailed demographic data of participants (eg, age, geographic region, race/ethnicity) were not accessible owing to SHG's privacy policies; therefore, while recruitment was designed to reflect a broad cross-section of individuals with recurrent dizziness, true representativeness could not be verified. As with most opt-in online panels, participation required internet access and self-selection, which may bias the sample toward individuals who are more health literate, technology-comfortable, or motivated by their condition. These limitations were accounted for by framing the study as descriptive and hypothesis-generating rather than confirmatory.

Survey Instrument and Measure

The survey included a 9-item questionnaire on demographics and attack characteristics, and a 16-item questionnaire focusing on the perspectives toward current dizzy attack diagnostic tools, treatments offered, and novel technology. The questionnaires were created based on their ability to capture the nuanced experiences of individuals with dizzy attacks. The survey instrument was reviewed by 2 domain experts in neurotology, vestibular neurology, and patient-centered outcomes to ensure content relevance and face validity. No formal psychometric validation was performed. Widely validated tools, such as the Dizziness Handicap Inventory or the patient satisfaction questionnaire short form measures were reviewed but not included, as the goal of this exploratory study was to capture broad patient perspectives on diagnostic and treatment experiences rather than quantify symptom severity or handicap. Dizzy attack patients were categorized according to the frequency of attacks: “infrequent” for those occurring a few times a year, “monthly” for a few times a month, “weekly” for a few times a week, and “daily” for those occurring every day. To ensure adequate representation of more frequent attacks, both infrequent and monthly categories were capped at 40 participants each.

This cross-sectional survey study was hypothesis-generating and aimed to assess patient-reported experiences with dizziness diagnosis and management, while assessing receptivity to the concept of a wearable at-home dizziness monitor.

Results

All results reported below are descriptive, reflecting the exploratory and hypothesis-generating nature of this study.

Demographics and Dizzy Attack Characteristics

Of the 250 respondents, there were 79 males and 171 females. This corresponds to 32% male and 68% female participants. The duration of the attacks was self-reported as seconds to minutes (n = 141, 56%), minutes to hours (n = 90, 36%), and hours to days (n = 19, 8%). The frequency of attacks was as follows: 16% (n = 40) of participants had infrequent attacks (defined as a dizzy attack occurring a few times a year), 16% (n = 40) had monthly attacks (defined as a dizzy attack occurring a few times a month), 49% (n = 122) had weekly attacks (defined as a dizzy attack occurring a few times a week), and 19% (n = 48) had daily attacks (defined as a dizzy attack occurring every day). Most respondents (n = 196, 78%) reported experiencing episodic dizziness for more than a year. A total of 111 (44%) respondents reported having little understanding of their dizzy attacks. A complete list of questions and responses is provided in Supplemental Table 1.

Patient Perspectives on Diagnosis and Treatment

Among the respondents, 16% (n = 39) reported a diagnosis of BPPV, 16% (n = 40) of VM, and 5% (n = 12) of MD, while the majority (60%, n = 150) had not received any of these specific vestibular diagnoses (Figure 1). In response to “Which clinicians have you visited in order to diagnose, understand, or work out the cause of your dizzy attacks?,” primary care physicians were the most consulted (infrequent, n = 24; monthly, n = 29; weekly, n = 95; daily, n = 30), followed by neurologists and otolaryngologists, while audiologists were the least consulted (infrequent, n = 0; monthly, n = 0; weekly, n = 7; daily, n = 4). Notably, regardless of the specialist, the weekly and daily categories had a higher percentage of visitation.

Figure 1.

Dizzy attack patient diagnosis distribution. The majority, 60%, did not receive a diagnosis corresponding to the specified categories. The remaining participants were diagnosed with benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), or Meniere's disease (MD), accounting for 16%, 16%, and 5% of the cases, respectively.

When asked, “How satisfied are you with the current medical tools that have been offered to you to DIAGNOSE and understand your dizzy attacks?,” 33% (n = 82) of the respondents reported satisfaction. When stratified by frequency of attacks, satisfaction with diagnostic tools was highest among those with infrequent episodes (48%) and lowest among those with weekly episodes (27%). Notably, dissatisfaction increased with attack frequency, reported by 30% (infrequent), 40% (monthly), 47% (weekly), and 46% (daily). In assessing satisfaction with the treatment options for dizzy attacks with the question, “How satisfied are you with the current options that have been offered to you to TREAT your dizzy attacks?,” 27% of the participants indicated satisfaction. Stratified by attack frequency, treatment option satisfaction levels were 43%, 28%, 22%, and 27% for infrequent, monthly, weekly, and daily attacks, respectively. Notably, those who were not satisfied with the treatment options were more prevalent among participants with more frequent attacks: 25% for infrequent, 40% for monthly, 48% for weekly, and 54% for daily episodes. Figure 2 illustrates the overall satisfaction levels with the diagnostic tools and treatments offered.

Figure 2.

The patient reported satisfaction with the current options that were offered to treat their dizzy attack episodes. The line graph illustrates the percentage of patients reporting dissatisfaction with diagnostic tools (black line) and treatments (pink line) across varying frequencies of dizzy attacks—ranging from “infrequent” to “daily.”

When prompted with the question, “One of the main challenges with diagnosing dizzy attacks is that they happen when you're not in the doctor's office and feel better when you go to see the doctor. It is frustrating that the doctor has difficulty understanding what the dizzy attack felt like or why it is occurring,” 82% (n = 205) of the participants expressed agreement. Further stratification revealed that the agreement varied with the frequency of attacks: 68%, 73%, 88%, and 88% among infrequent, monthly, weekly, and daily attacks, respectively. In response to the question, “Given the difficulty of capturing a dizzy attack when they occur, there is frustration, or it takes a long time and many visits to get a proper diagnosis for dizzy attacks. I feel I have tried many treatments with no benefit because I do not have a distinct diagnosis,” a total of 63% (n = 157) of the cohort reported an agreement. A stratified analysis showed that this agreement intensified with the frequency of attacks: 33% for those experiencing infrequent attacks, 50% for monthly attacks, 71% for weekly attacks, and 77% for those with daily attacks. The responses are shown in Figure 3.

Figure 3.

The patient reported satisfaction with the current options that have been used to diagnose dizzy attack episodes.

Perspectives on a Novel At-Home Attack Recording Device

In response to the question, “In general, how comfortable are you with technology?,” most respondents (76%, n = 189) reported feeling comfortable. Participants were presented with a conceptual description of a hypothetical, wearable, at-home device designed to capture dizzy attacks in real time. The prompt described the device as having high diagnostic potential (eg, >90% accuracy), based on a theoretical model. Participants viewed an image (Figure 4a) accompanied by the following description: “This is an advanced, wear-at-home device that captures dizzy attacks while they happen and leads to a highly accurate diagnosis (greater than 90% accuracy). Unlike other testing methods that are not designed to capture a dizzy attack while it is in process, this device is intended to be worn continually until a dizzy attack is captured. The device is designed to be a comfortable and flexible patch (similar to a Band-Aid), which is worn next to the eye on 1 side of the face continuously for up to 2 weeks.” Subsequently, when asked, “Please indicate whether you agree or disagree with each statement regarding the wearable at-home attack monitor,” 79% (n = 198) of the participants expressed interest in learning more, with interest stratified by frequency: 60% for infrequent, 70% for monthly, 86% for weekly, and 85% for daily. Regarding the likelihood of trying the device, 72% of the participants were in favor, with a breakdown of 45% for infrequent, 60% for monthly, 78% for weekly, and 88% for daily attacks.

Figure 4.

(a) A computer-generated model of a wearable at-home dizzy attack monitor used for continuous monitoring of dizzy attacks. Participants were informed that the device, resembling a comfortable patch and offers over 90% diagnostic accuracy. It is meant to be worn next to the eye on 1 side of the face for up to 2 weeks, capturing dizzy attacks as they occur to facilitate an accurate diagnosis. (b) An alternative version of the wearable at-home dizzy attack monitor available for immediate use. Participants were briefed that while this version ensures the same high functionality and diagnostic accuracy as the advanced model, its design is not yet refined.

Additionally, participants were shown an alternative image (shown in Figure 4b) with the accompanying description: “Imagine that the final version of the device will be released in 3 years. However, a beta version is available immediately at a fair and reasonable price. This version maintains the same functionality and high diagnostic accuracy, but the design's aesthetics are not yet optimized.” When asked about their willingness to use the alternative version if it was the only 1 available for diagnosing their dizzy attacks, 33% of the participants indicated that they were likely to try the device. The likelihood of trying the device was stratified according to the frequency of dizzy attacks: 18% for infrequent, 23% for monthly, 40% for weekly, and 69% for daily attacks. Conversely, 41% of the participants indicated no interest in trying the alternative version, with a breakdown of 72% for infrequent, 55% for monthly, 34% for weekly, and 21% for daily attacks.

When addressing the question, “If the doctor was confident in your diagnosis, based on the wearable at-home attack monitor test result, how likely would you still push for other existing dizziness diagnostic tests (such as MRI or balance tests) even if the doctor felt they were not needed?,” 25% of the participants (n = 62) indicated the likelihood of requesting additional testing. Stratification by the frequency of dizzy attacks revealed that 12%, 20%, 26%, and 38% of the participants with infrequent, monthly, weekly, and daily attacks, respectively, were inclined to pursue further diagnostic procedures.

When asked about the priority for outward appearance of the device for personal use, participants expressed a clear preference for a “camouflaged” design, with 66% (n = 166) favoring an appearance that “doesn't stand out.” An “aesthetically pleasing” design was also important and selected by 60% (n = 151) of the participants. Fewer participants, 43% (n = 107), prioritized a design that “doesn't resemble a medical device.” The least favored attribute was “high-tech appearance,” chosen by 30% (n = 76) of the participants. Stratification by the frequency of dizzy attacks showed the highest preference for “camouflage” among infrequent attack sufferers at 73% (n = 29), and the highest preference for an “aesthetically pleasing” design among those with daily attacks at 77% (n = 37). Full response distributions for all 16 wearable-related survey items are detailed in Supplemental Table 2.

Discussion

Our study revealed an association between the frequency of dizzy attacks and patient satisfaction with the diagnostic tools and treatments offered. Specifically, a higher frequency is associated with greater dissatisfaction, which may stem from the continuous impact of attacks. Patients with more frequent attacks were also more likely to consult specialist clinicians, suggesting a search for more effective management strategies, owing to the inadequacies of standard practices. This finding is consistent with previous studies showing the average dizzy patient seeing 4.8 different providers. ²⁵ Interestingly, a large portion of our respondents (60%), irrespective of attack frequency, were not diagnosed with BPPV, VM, or MD, echoing the complexities and challenges inherent in diagnosing dizzy attacks. ⁸ This finding is in line with research by Kerber, suggesting that patients with dizziness often have low confidence in obtaining accurate diagnoses from their healthcare providers—a factor that may contribute to the decreased satisfaction observed in our study. ²⁰ Additionally, we found that the spontaneity of attacks also may play a role in the dissatisfaction. Our study revealed that a substantial proportion of patients experiencing high-frequency attacks concur that their episodes often occur outside the clinical environment, complicating the physician's ability to comprehend the experience and etiology of the attacks. Given that clinicians depend on patient narratives, which have been shown to be unclear and inconsistent, there is an evident need for objective and reliable out-of-office diagnostic methods. ²⁶ Such innovations could provide clinicians with precise data, mitigating the current reliance on often ambiguous patient descriptions and steering toward more accurate, patient-centric diagnostic pathways.

Our study underscores a favorable disposition toward technology among patients experiencing dizzy attacks, with an overwhelming majority (79%) expressing interest in a wearable at-home attack monitor (Figure 4a). This interest is even more pronounced in patients with frequent attacks, 90% of whom are amenable to using an alternative device (Figure 4b), which, although not yet refined in design, offers the same functional capabilities. Their readiness to embrace such devices may be driven by the pressing challenges faced: delayed diagnoses, extended symptom durations, the financial burden of current care strategies, and general dissatisfaction with existing diagnostic and treatment modalities.^11,19,21

Future Directions and Clinical Implications

These findings highlight several opportunities to advance the diagnosis and management of dizziness. Integrating real-time capture of patient-reported events into clinical workflows could enable earlier diagnosis of recurrent dizzy attacks and reduce the need for multiple consultations or redundant testing. The development of wearable vestibular monitoring devices should prioritize both diagnostic accuracy and patient comfort, ensuring that technology augments rather than complicates clinical decision-making. Future research should focus on validating wearable-based diagnostic models against gold-standard vestibular tests and evaluating their impact on healthcare efficiency, cost, and patient satisfaction.

Strengths and Limitations

Our study represents an initial exploration of patient perspectives on the management and diagnosis of dizzy attacks, specifically examining their interest in a wearable at-home attack monitor. This is one of the few studies to address patient receptivity toward such technology across a broad spectrum of dizziness symptoms, not just those with vestibular origins. However, these interpretations must be considered within the limitations of the present study. The sample size was modest, and the recruitment relied on a single online panel that is based on voluntary participation. This introduces potential selection bias toward individuals with higher digital access, health literacy, or motivation to share their experiences. The lack of accessible demographic variables—particularly age, socioeconomic status, and geographic region—precluded assessment of representativeness or stratified subgroup analysis. As a result, generalizability to the broader population of patients with dizziness is limited. Furthermore, the hypothetical nature of the wearable device concept and reliance on self-reported data may influence response accuracy. These constraints reinforce that the findings should be viewed as exploratory and hypothesis-generating, guiding future confirmatory research using validated instruments and probabilistic sampling.

Conclusion

In conclusion, our study revealed that patients with a higher frequency of dizzy attacks expressed dissatisfaction with current standards of diagnosis and treatment. As well as higher agreement that a major challenge is the spontaneity of attacks occurring outside the clinic and away from diagnostic testing. Additionally, patients with higher frequency show increased receptivity and interest toward a wearable at-home attack monitor that would aid in diagnosis.

Supplemental Material

sj-docx-1-jpx-10.1177_23743735261416352 - Supplemental material for Patient Perspectives on Episodic Dizziness and a Hypothetical At-Home Diagnostic Tool

Supplemental material, sj-docx-1-jpx-10.1177_23743735261416352 for Patient Perspectives on Episodic Dizziness and a Hypothetical At-Home Diagnostic Tool by Donald Paul Keating, Kristen Kay Steenerson, Ankur Gupta and Peter Luke Santa Maria in Journal of Patient Experience