Dizziness Symptom Profile (DSP): A Full Guide for Researchers and Clinicians
By ResRef
Published
Learn about the Dizziness Symptom Profile (DSP): what it measures, how it is scored and interpreted, and how researchers and clinicians use it.
Introduction
Dizziness Symptom Profile (DSP) is a self-report case-history questionnaire that generates one or more differential diagnoses for patients with dizziness, vertigo, or unsteadiness. Clinicians intend to combine its results with the patient’s clinical history and physical examination to guide further evaluation and management. Gary P. Jacobson and his colleagues first developed this instrument under a 2018 online copyright, and the official journal issue subsequently indexed the study in 2019 to provide systematic case-history insights. Consequently, researchers and medical professionals widely recognize the tool for its ability to identify symptom patterns and narrow down diagnostic probabilities. With over 35 citations in scientific literature, it consistently demonstrates its clinical utility across specialized neurotology settings.
This article delves into the instrument's core features, practical applications, and overall clinical value. Furthermore, it aims to provide researchers and clinicians with actionable insights to enhance patient assessment and improve care in vestibular medicine.
Key Features of the Dizziness Symptom Profile (DSP)
Purpose and Use
The primary purpose of the DSP centers on generating actionable differential diagnoses for patients who experience balance disruptions. This workflow includes tracking short-lasting positional vertigo, prolonged severe spells, and migraine-associated symptoms. By utilizing the DSP, clinicians and researchers can effectively organize subjective symptom clusters before formal testing. Ultimately, this approach leads to more targeted interventions and streamlined patient management. However, professionals must always combine these results with physical examinations, as the profile serves as a clinical adjunct rather than a standalone definitive instrument.
Target Population
The validation data supports the use of the DSP with adults aged 18 years and older. This expansive target population specifically includes:
Young adults (18–24 years)Middle-aged adults (25–44 years)Older adults (45–64 years)Seniors (65+ years)Consequently, neurotologists apply this tool to individuals who suffer from acute or chronic vestibular symptoms, structural imbalance, or related secondary anxiety.
Structure
The final configuration of the DSP consists of 31 items. During development, the authors evaluated an initial pool of 64 items, which they reduced to 35, before finalizing the current 31-item layout. These items smoothly map onto seven specific diagnostic subscales:
Vestibular migraineMeniere’s diseaseBenign paroxysmal positional vertigoSuperior canal dehiscenceVestibular neuritis/labyrinthitisPersistent postural-perceptual dizzinessUnspecified unsteadinessAdditionally, the comprehensive item design ensures that the questionnaire fully covers symptom patterns relevant to common vestibular and dizziness-related disorders. Specifically, the items assess short-lasting positional vertigo, prolonged severe vertigo spells, and migraine-associated symptoms. Furthermore, the tool evaluates unilateral auditory symptoms such as hearing change, roaring tinnitus, and ear pressure. Finally, the profile measures chronic unsteadiness or daily imbalance, cough/sneeze/straining-related dizziness, and anxiety- or depression-associated dizziness symptoms.
Scoring Method
Each DSP item utilizes a 5-point Likert-type agreement scale ranging from 0 to 4:
0: Strongly disagree1: Disagree2: Neutral3: Agree4: Strongly agreeBecause the individual diagnostic subscales contain unequal numbers of items, clinicians normalize the raw subscale scores to a 0–100% scale.
During preliminary validation, the authors operationally defined a normalized subscale score ≥60% as a positive endorsement. Conversely, they defined a score <40% as a negative endorsement. Therefore, higher scores reveal a greater probability of that specific condition. However, users should interpret these thresholds as descriptive diagnostic probabilities rather than strict, categorical cut-off scores.
Administration Format
The DSP is an entirely self-administered questionnaire, meaning that patients can complete it independently without specialized clinical oversight. Furthermore, healthcare teams can deploy the tool across multiple administrative formats:
Paper-based formsDigital (online) platformsIn-person structured interviewsPhone or video consultationsTypically, patients require 15 to 30 minutes to complete all 31 questions. This timeframe guarantees highly detailed, actionable anamnesis insights for busy specialized clinics.
Application of the Dizziness Symptom Profile (DSP)
The DSP offers extensive advantages across several domains within ENT, otology, and neurotology:
Screening: It acts as an efficient triage filter to isolate complex vestibular symptom patterns, allowing clinics to prioritize high-risk patients.Treatment Planning: Medical providers utilize baseline subscale percentages to plan specialized vestibular rehabilitation therapy (VRT) regimens.Research: Academic authors employ the standardized 0–100% normalized scores as objective baseline metrics or outcome variables in observational clinical trials.Languages and availability
The original validation studies establish the tool primarily in English. However, researchers have successfully expanded its cross-cultural footprint by publishing a validated Persian version.
In terms of cost, the tool remains completely free for educational and non-commercial research access. Because it operates under a restricted access model, professionals should seek formal permissions from Vanderbilt University before pursuing digital/proprietary app development or new translations.
Reliability and Validity
Statistical tracking shows that the DSP remains a moderately reliable and valid tool. A dedicated test-retest study reported strong individual item correlations ranging from 0.67 to 0.91. Similarly, the subscale intraclass correlation coefficients (ICCs) proved excellent, spanning from 0.85 to 0.94. The minimal detectable change (MDC) values ranged from 16% to 25% across the subscales. Most importantly, preliminary trials demonstrated a 70.3% overall diagnostic agreement with otologist-generated clinical assessments, showing peak accuracy for Meniere’s disease, vestibular migraine, and BPPV.
The original validation study link.Test-Retest Reliability of the Dizziness Symptom Profile study link.Validation of the Persian version study link.Limitations and Considerations
Despite its strengths, the DSP has a few limitations:
Self-report measure: Subjective personal interpretations or current emotional states may distort patient responses.Language Barriers: The scarcity of validated global translations limits immediate multicultural deployment.Limited Validation Studies: The scale requires further large-scale international replication data across diverse medical centers.Age Restrictions: The current psychometric data restricts its application to adult populations, meaning it is not validated for patients under 18 years of age.Social Desirability Bias: Patients may intentionally over-report or minimize severe dizziness symptoms due to personal biases.Other Versions And Related Questionnaires
Currently, no official short forms or alternative structural variations of the DSP exist. Nevertheless, researchers frequently combine the diagnostic profile with complementary functional, physical, or psychological balance instruments. These complementary tools include:
DHI: Dizziness Handicap InventoryVSS: Vertigo Symptom ScaleVVAS: Visual Vertigo Analogue ScaleABC: Activities-specific Balance Confidence ScaleMSQ: Motion Sensitivity QuestionnaireAdditional Resources
The original validation study link.You can access the questionnaire as a PDF through this link.For inquiries, contact Gary P. Jacobson, the first author of the questionnaire at gary.jacobson@vanderbilt.edu.Frequently Asked Questions (FAQ)
Who can use the DSP?Clinicians, researchers, and healthcare providers use the DSP for adult patients aged 18 and older who present with dizziness, vertigo, or unsteadiness.
How long does it take to complete the DSP?Patients typically take 15 to 30 minutes to complete the DSP, which makes it comprehensive and feasible for targeted research settings.
How is the DSP administered?Healthcare teams can administer the questionnaire via paper, digital, in-person interviews, or phone/video formats—offering excellent clinical flexibility.
Is there any cost to using the DSP?The DSP is free for educational and research purposes. For commercial deployment or digital proprietary implementation, acquiring direct author permission is necessary
A Word from ResRef about the Dizziness Symptom Profile (DSP)
The DSP is a 31-item self-report case-history tool developed to support differential diagnosis generation in patients with dizziness, vertigo, or unsteadiness. In preliminary validation, it showed approximately 70.3% overall agreement with otologist-generated differential diagnoses, with stronger agreement for Meniere’s disease, vestibular migraine, and BPPV. It should be used as an adjunct to clinical history and physical examination, not as a standalone diagnostic instrument.
References
Jacobson GP, Piker EG, Hatton K, et al. Development and Preliminary Findings of the Dizziness Symptom Profile. Ear and Hearing. 2019 May/Jun;40(3):568-576. link.Landon-Lane RL, Piker EG, Jacobson GP, Hatton K, Roberts RA. Test-Retest Reliability of the Dizziness Symptom Profile. Ear Hear. 2021 Jan/Feb;42(1):206-213. link.Soleimani, H., McCaslin, D. L., Ghahraman, M. A., Jalaie, S., Kouhi, A., Borghei, P., & Hoseinabadi, R. (2025). Translation and Assessment of the Validity, Reliability, Sensitivity, and Specificity of the Persian Version of the Dizziness Symptom Profile. Auditory and Vestibular Research, 35(1). link.