Posturographic Assessment of Sway Misperception Accurately Identifies Persistent Postural-Perceptual Dizziness in Neurotologic Patients.

OBJECTIVE

To assess whether a posturographic assessment of sway misperception (PASM) discriminates persistent postural-perceptual dizziness (PPPD) from peripheral balance disorders.

METHODS

We retrospectively reviewed adults (≥ 18 years) evaluated at Saitama Medical University Hospital between September 2024 and April 2025 with PPPD (Bárány Society diagnostic criteria) or peripheral balance disorders who underwent PASM; central/psychogenic disorders were excluded. On a stabilometer, postural sway area (PSA) and velocity of path length (VPL) were recorded during eyes-closed standing. Then, with eyes open, patients completed a "reproduction" trial: they were asked to intentionally recreate the instability they had just perceived by deliberately swaying to match the subjective magnitude, rather than standing still. Reproduction rates (RRs) were calculated as eyes-open reproduced/eyes-closed recorded values for PSA and VPL. Groups were compared with Mann-Whitney U tests, and ROC analyses estimated AUCs and cutoffs.

RESULTS

Nineteen PPPD patients (11 women; 50.2 (16.4) years, mean (SD)) and 20 peripheral cases (10 women; 53.8 (13.3) years) were analyzed. Eyes-closed PSA and VPL were similar (p > 0.05), but PSA RR (4.0 (1.5) vs. 1.7 (0.7)) and VPL RR (1.6 (0.5) vs. 1.1 (0.4)) were higher in PPPD (p < 0.001 and p = 0.001, respectively). PSA RR discriminated PPPD with an AUC of 0.94 (95% CI, 0.87-1.00); cutoff ≥ 1.89 yielded sensitivity 1.00 and specificity 0.75. VPL RR showed an AUC of 0.81 (95% CI, 0.67-0.95); cutoff ≥ 1.55 yielded sensitivity 0.63 and specificity 0.90.

CONCLUSIONS

PASM quantifies exaggerated perceived sway in PPPD. An intentional sway-reproduction task, particularly PSA RR, may provide a practical objective biomarker for diagnosis of PPPD.

LEVEL OF EVIDENCE: 4.