Visual vertigo analogue scale: An assessment questionnaire for visual vertigo

Dannenbaum, Elizabeth; Chilingaryan, Gevorg; Fung, Joyce

doi:10.3233/ves-2011-0412

Cited by 148Vestibular and auditory disordersBalance, Gait, and Falls PreventionNausea and vomiting management

Visual vertigo analogue scale: An assessment questionnaire for visual vertigo

Dannenbaum, Elizabeth, Chilingaryan, Gevorg, Fung, Joyce·2011·Journal of Vestibular Research

DOI 10.3233/ves-2011-0412

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Abstract

A common symptom for people with vestibulopathy is dizziness induced by dynamic visual input, known as visual vertigo (VV). The goal of this study is to present a novel method to assess VV, using a nine-item analog scale. The subjects rated the intensity of their dizziness on each item of the Visual Vertigo Analogue Scale (VVAS), which represented a daily situation typically inducing VV. The questionnaire was completed by participants with vestibulopathy (n=102) and by subjects receiving out-patient orthopaedic physiotherapy (n=102). The dizziness handicap inventory (DHI) was also completed by the vestibulopathic group. The Cronbach's Alpha index indicated the VVAS is internally consistent and reliable (Cronbach's Alpha=0.94). The study also found that the VVAS severity scores from vestibular and a non-vestibular population were significantly different (Wilcoxon-Mann Whitney test p < 0.0001). Spearman correlation analysis conducted between DHI and VVAS scores for the clients with vestibulopathy showed positive moderate correlations between the VVAS score and the total DHI score (r=0.67, p< 0.0001). This study showed that the VVAS scale may be useful in providing a quantitative evaluation scale of visual vertigo.

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The VVAS consists of nine items to rate on a visual analogue scale, each pertaining to a specific situation that provokes visual vertigo.
“The VVAS consists of nine items to rate on a visual analogue scale. Each item pertains to a specific situation that provokes VV [5].”
From A Pilot Study to Assess Visual Vertigo in People with Persistent Postural–Perceptual Dizziness with a New Computer-Based Tool (2023) · cites this paper as [5]
The c-VVAS is specific to the PPPD population, similar to the p-VVAS.
“This demonstrates that the tool is specific to PPPD population, similar to the p-VVAS [5].”
From A Pilot Study to Assess Visual Vertigo in People with Persistent Postural–Perceptual Dizziness with a New Computer-Based Tool (2023) · cites this paper as [5]

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“34,35 PCS was diagnosed according to the International Classification of Diseases , 10th Revision (ICD-10) criteria, relying on the patient’s clinical history and subjective symptomatology.”
Traducción y adaptación transcultural del cuestionario Visual Vertigo Analogue Scale para uso en Argentina
Verdecchia, D. H., Hernandez, D., Andreu, M. F., & Salzberg, S. (2020) · Acta Otorrinolaringológica Española · doi:10.1016/j.otorri.2019.10.003 · Cited by 7 · see citing works
Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial
Hao, W., Zhao, L., Yu, H., et al. (2020) · Trials · doi:10.1186/s13063-020-04579-6 · Cited by 7 · see citing works
Compression versus no compression after endovenous radiofrequency ablation: A meta-analysis of randomized controlled trials
Zhang, D., Shi, C., Zhang, Y., et al. (2022) · Phlebology The Journal of Venous Disease · doi:10.1177/02683555221108568 · Cited by 7 · see citing works
“Post-operative pain was assessed using the 100 mm Visual Analogue Scale (VAS).(13)”
Method
Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study
Verdecchia, D. H., Monzón, A. M., Jaimes, V. U., et al. (2018) · Journal of Aging Research · doi:10.1155/2018/5093501 · Cited by 7 · see citing works
“,e patients who gave positive results in the clinical vestibular tests were included in the study [19].”
Result
L’Asthénopie Vestibulaire
Bauwens, A. (2017) · Revue Francophone d Orthoptie · doi:10.1016/j.rfo.2017.10.001 · Cited by 8 · see citing works
The Portuguese version of the visual vertigo analog scale
Amorim, A. M., Simões, J., Gonçalves, J., Ferreira, M. D. S., & Ribeiro, J. C. (2022) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2022.09.004 · Cited by 6 · see citing works
INTRAVENOUS PROMETHAZINE VERSUS DIAZEPAM FOR TREATMENT OF PERIPHERAL VERTIGO IN EMERGENCY DEPARTMENT
Shafipour, L., Iraj, G. K., Shafipour, V., et al. (2017) · Majallah-i dānishgāh-i ̒ulūm-i pizishkī-i Māzandarān/Journal of Mazandaran University of Medical Sciences · Cited by 6 · see citing works
Pediatric Vestibular Rehabilitation: A Case Study
Alves, C. C., & Silva, A. L. D. S. (2019) · Pediatric Physical Therapy · doi:10.1097/pep.0000000000000654 · Cited by 6 · see citing works
Vestibular-guided visual search
Smith, L. J., Gkioka, A., & Wilkinson, D. T. (2020) · Experimental Brain Research · doi:10.1007/s00221-020-05741-x · Cited by 6 · see citing works
Arabic version of the visual vertigo analogue scale for assessment visual vertigo syndrome
Talaat, H. S., Abedein, A. Z. E., & Ali, R. (2019) · Egyptian Journal of Ear Nose Throat and Allied Sciences · doi:10.21608/ejentas.2019.9894.1081 · Cited by 5 · see citing works
“The VVAS is a 9-item questionnaire that can be completed by the patient to assess their intensity of VV in challenging situations of visual motions that typically provoke dizziness; the individuals marked a vertical line on 100 millimeters straight line[15].”
BackgroundMethodResultInfluential
Predictors of Chronic Dizziness in Acute Unilateral Vestibulopathy: A Longitudinal Prospective Cohort Study
Laer, L. V., Hallemans, A., Somer, C. D., de Varebeke, S. J., Fransén, E., Schubert, M., Rompaey, V. V., & Vereeck, L. (2024) · Otolaryngology · doi:10.1002/ohn.964 · Cited by 5 · see citing works
Visual fixations and visually induced dizziness: An exploratory study
Chaudhary, S., Barbado, D., Saywell, N. L., & Taylor, D. (2022) · Gait & Posture · doi:10.1016/j.gaitpost.2022.02.002 · Cited by 5 · see citing works
Clinical characteristics and diagnostic aspects of cervicogenic dizziness in patients with chronic dizziness: A cross-sectional study
Vestel, C. D., Vereeck, L., Rompaey, V. V., Reid, S. A., & Hertogh, W. D. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102559 · Cited by 5 · see citing works
Utility of VestAid to Detect Eye-Gaze Accuracy in a Participant Exposed to Directed Energy
Whitney, S. L., Ou, V., Hovareshti, P., et al. (2022) · Military Medicine · doi:10.1093/milmed/usac294 · Cited by 5 · see citing works
Cross-cultural adaptation and construct validity of the Chinese Version of Visual Vertigo Analogue Scale by using structural equation modeling
Li, X., Yu, H.-Y., Li, J., Liu, X.-L., Zheng, H.-Y., Li, Y., Li, Q., & Liu, S. (2023) · Journal of Vestibular Research · doi:10.3233/ves-220102 · Cited by 5 · see citing works
“Visual vertigo (VV) manifests with one or more symptoms of dizziness, unsteadiness, or non-spinning vertigo that are exacerbated by exposure to moving or complex visual stimuli, e.g., being in fast moving trafﬁc, walking through supermarkets or shopping mall, watching action movies, and so on [5].”
Influential
Can head sway patterns differentiate between patients with Meniere’s disease vs. peripheral vestibular hypofunction?
Kelly, J., Cosetti, M. K., & Lubetzky, A. V. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1347335 · Cited by 5 · see citing works
“The VVAS is a subjective scale where the participants mark the intensity of their dizziness on a scale of 0 to 10 cm for each of 9 situations of visual motion that typically provoke dizziness (28).”
Background
Sense of direction in vestibular disorders
Moore, A. I. G., Golding, J. F., Alenova, A., Castro, P., & Bronstein, A. M. (2024) · Journal of Vestibular Research · doi:10.3233/ves-230082 · Cited by 5 · see citing works
“The Visual Vertigo Analogue Scale consists of 9 items on which participants rate their perceived dizziness on a scale between 0 (no dizziness) and 10 (most dizziness) in different visual vertigo-inducing environments [12].”
Physical Therapy Treatment of a Person Exposed to Directed Energy: A Case Report
Whitney, S. L., Hoppes, C. W., Lambert, K. H., & Klatt, B. N. (2021) · Military Medicine · doi:10.1093/milmed/usab256 · Cited by 5 · see citing works
Vestibular asthenopia
Bauwens, A., & LaRock, F. (2021) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2021.05.008 · Cited by 5 · see citing works
Visually induced dizziness
Steenerson, K. K., Hoskin, J. L., & Fife, T. D. (2021) · Current Opinion in Neurology · doi:10.1097/wco.0000000000001022 · Cited by 5 · see citing works
“The Visual Vertigo analog scale (VVAS) was an additional questionnaire developed to assess VID, particularly in patients with a prior vestibulopathy [16].”
Method
Altered visual conscious awareness in patients with vestibular dysfunctions; a cross-sectional observation study
Sharif, M., Saman, Y., Burling, R., Rea, O., Patel, R. P., Barrett, D., Rea, P. A., Kheradmand, A., & Arshad, Q. (2023) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2023.120617 · Cited by 5 · see citing works
Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial
Dhiman, N. R., Joshi, D., Gyanpuri, V., et al. (2023) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_12_23 · Cited by 5 · see citing works
“[16] Nystagmus was analyzed visually and recorded as a video on mobile phone.”
Feasibility of gamified visual desensitisation for visually-induced dizziness
Goodwin, N., Powell, G., Loizides, F., Derry-Sumner, H., Rajenderkumar, D., & Sumner, P. (2024) · Scientific Reports · doi:10.1038/s41598-024-67745-9 · Cited by 5 · see citing works
“Volunteers were initially screened with the Visual Vertigo Analogue scale (VVAS) in which nine environments and triggers (commonly associated with visually-induced dizziness) are rated from 0–10 for the degree they evoke dizziness 13 .”
Dizziness in a Child With Irlen Syndrome: Differentiating Visual and Vestibular Complaints
Hoppes, C. W., Morrell, R. L., Woelfel, L. W., & Whitney, S. L. (2019) · Pediatric Physical Therapy · doi:10.1097/pep.0000000000000652 · Cited by 4 · see citing works
Validated argentine version of the visual vertigo analogue scale
Verdecchia, D. H., Hernandez, D., Andreu, M. F., Salzberg, S., & Whitney, S. L. (2021) · Journal of Vestibular Research · doi:10.3233/ves-210062 · Cited by 4 · see citing works
“The VVAS-A is a 9-item self-administered questionnaire developed to assess VV [13].”
Influential
Psychometric Properties of the Short Version of the Activities-Specific Balance Confidence Scale in Vestibular Patients
Castillejos-Carrasco-Muñoz, R., Ibáñez‐Vera, A. J., Peinado-Rubia, A. B., et al. (2023) · Otology & Neurotology · doi:10.1097/mao.0000000000003807 · Cited by 4 · see citing works
Translation and validation of a Swedish version of the Visual Vertigo Analogue Scale
Wibble, T., & Pansell, T. (2023) · Annals of Medicine · doi:10.1080/07853890.2023.2177724 · Cited by 4 · see citing works
“The Visual Vertigo Analogue Scale (VVAS) was developed by Dannenbaum et al. as a derivative of the Longridge et al. aiming to identify patients with a visual aethiology for their complaints [4].”
MethodResultInfluential
Rehabilitación vestibular en la dependencia visual y somatosensorial.
Bauer, M., Benito-Orejas, J. I., & Ramírez-Salas, J. E. (2019) · Revista ORL · doi:10.14201/orl.21241 · Cited by 5 · see citing works
Oculomotor and Perceptual Measures of Visual Motion Sensitivity in Patients With Chronic Dizziness Symptoms
Zaleski-King, A., Pinto, R., Tamaki, C., Bogle, J. M., McCaslin, D., & Brungart, D. S. (2022) · Ear and Hearing · doi:10.1097/aud.0000000000001206 · Cited by 4 · see citing works
“DHI, Dizziness Handicap Inventory; GAD-7, Generalized Anxiety Disorder Screener; PHQ, Patient Health Questionnaire Screener; VVAS, Visual Vertigo Analog Scale. chronically dizzy patients with and without identified peripheral vestibular impairment were quantified.”
MethodInfluential
Vestibular rehabilitation following surgical repair for Superior Canal Dehiscence Syndrome: A complicated case report
Carender, W. J., & Grzesiak, M. (2017) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2017.1374491 · Cited by 3 · see citing works
“The Visual Vertigo Analogue Scale has been used to assist practitioners and patients in identifying and quantifying specific situations or environments that trigger visual-related dizziness (Dannenbaum et al. 2011).”
Method
Clinical practicality of the dizziness handicap inventory for evaluating dizziness in the Mandarin Chinese-speaking population: a prospective cross-sectional analysis
Fei, Y., Zheng, Y., Meng, H., et al. (2020) · International Journal of Audiology · doi:10.1080/14992027.2020.1839677 · Cited by 3 · see citing works
Electrodermal and postural responses in dizzy adults: Diagnostic indicators of vestibular migraine
Al-Sharif, D. S., Tucker, C. A., Coffman, D. L., & Keshner, E. A. (2022) · Journal of Vestibular Research · doi:10.3233/ves-220004 · Cited by 4 · see citing works
“…at the beginning of the experiment using the following validated clinical tools: VVM Questionnaire, [35] Visual Vertigo Analog Scale (VVAS), [20] Dizziness Handicap Inventory (DHI), [30] Vertigo Symptoms Scale-Short Form (VSS-SF), [63] Activi-tiesofBalanceConﬁdence(ABC)questionnaire,[40]…”
Development and Validation of the Vision-Related Dizziness Questionnaire
Armstrong, D., Alderson, A. J., Davey, C. J., et al. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00379 · Cited by 3 · see citing works
“The Visual Vertigo Analog Scale (14) is a nine-item visual analog scale to assess the intensity of symptoms for patients with Visual Vertigo which was developed using classical test theory.”
Method
Visual Fixations and Motion Sensitivity: Protocol for an Exploratory Study
Chaudhary, S., Saywell, N. L., Kumar, A., & Taylor, D. (2020) · JMIR Research Protocols · doi:10.2196/16805 · Cited by 3 · see citing works
“…in the vestibular disorder clinic) but have no current signs of acute vestibular deficits, are aged between 18 and 60 [40,41], have a history of motion sensitivity symptoms as reported by the Visual Vertigo Analogue Scale (score >5) [42-44], and score >40 on the Dizziness Handicap Inventory [44].”
Translation and cross-cultural adaptation of the Visual Vertigo Analogue Scale for use in Argentina
Verdecchia, D. H., Hernandez, D., Andreu, M. F., & Salzberg, S. (2020) · Acta Otorrinolaringologica (English Edition) · doi:10.1016/j.otoeng.2019.10.003 · Cited by 3 · see citing works
Virtual Environments for Rehabilitation of Postural Control DysfunctionPreprint
Wang, Z., Lubetzky, A. V., Gospodarek, M., et al. (2019) · arXiv (Cornell University) · doi:10.48550/arxiv.1902.10223 · Cited by 3 · see citing works
“The Visual Vertigo Analog Scale asks the patient to rate the intensity of their dizziness in nine situations of visual motions [5].”
Background
Medication-Related Dizziness in the Older Adult
Min, Y., Shoair, O. A., & Slattum, P. W. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-55136-6.00018-6 · Cited by 3 · see citing works
Visual Disorders and Mal De Debarquement Syndrome: a Potential Comorbidity questionnaire-based Study
Browne, C. J., Fahey, P. P., Sheeba, S. R., Sharpe, M. H., Rosner, M., Feinberg, D. L., & Mucci, V. (2022) · Future Science OA · doi:10.2144/fsoa-2022-0022 · Cited by 3 · see citing works
“However, the VVAS and SVQ questionnaires provides a quantitative evaluation scale of VID and identifies the presence of visual–vestibular conflict.”
MethodInfluential

Evaluation of the value of vestibular autorotation test in 214 patients with vertigo
Han, Y. (2013) · Beijing Medical Journal
Mann–Whitney U and Wilcoxon Signed‐Rank
Weaver, K. F., Morales, V., Dunn, S. L., et al. (2017) · doi:10.1002/9781119454205.ch7 · Cited by 5 · see citing works
Misconceptions Leading to Choosing the t Test Over the Wilcoxon Mann-Whitney Test for Shift in Location Parameter
Sawilowsky, S. S. (2005) · Journal of Modern Applied Statistical Methods · doi:10.22237/jmasm/1130804700 · Cited by 104 · see citing works
Nonparametric Two‐Sample Tests
Nelson, M. C. (2020) · doi:10.1002/9781119541509.ch7
Pengaruh Penambahan Stretching Exercises Pada Kompres Panas Terhadap Penurunan Nyeri Pada Neck Pain Syndrome
Falah, A., & Herawati, S. F. I. (2018) · UMS Library Center of Academic Activities (Universitas Surakarta) · Cited by 1 · see citing works

Authors: Dannenbaum, E., Chilingaryan, G., & Fung, J.
Affiliations: Jewish Rehabilitation Hospital (CA)
Corresponding author: Dannenbaum, Elizabeth
ORCID: Dannenbaum, Elizabeth
Fung, Joyce
Venue: Journal of Vestibular Research
Publisher: SAGE Publications
Published: 2011-06-01
Volume: 21
Issue: 3
Pages: 153-159
ISSN: 0957-4271 (ISSN-L)
1878-6464
DOI: 10.3233/ves-2011-0412
OpenAlex: W1582593651
Cited by: 145
References: 0
Citations by year: 2026: 18 · 2025: 10 · 2024: 11 · 2023: 21 · 2022: 17 · 2021: 15 · 2020: 18 · 2019: 11 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 1
FWCI: 1.24
Type: journal article
Language: en
Open access: closed
Locations: Journal of Vestibular Research (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Surgery › Nausea and vomiting management
Keywords: visual vertigo, vestibulopathy, dizziness handicap, scale development, questionnaire reliability
MeSH terms: Adult, Aged, Dizziness, Female, Humans, Male, Middle Aged, Outpatients, Pain Measurement, Surveys and Questionnaires, Vertigo, Vestibular Diseases

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Visual vertigo analogue scale: An assessment questionnaire for visual vertigo

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