OBJECTIVE: To explore the Nijmegen Questionnaire (NQ) and its relationship to vestibular function tests and symptoms in patients with dizziness; to compare patient characteristics between those with a positive Nijmegen score and patients clinically diagnosed with hyperventilation syndrome (HVS). STUDY DESIGN: Retrospective case series. SETTING: Tertiary neurotology referral center. PATIENTS: Patients seen at vestibular assessment were grouped according to positive (≥24) or negative (<24) Nijmegen scores; secondary analysis was performed on patients grouped by a clinical diagnosis of hyperventilation syndrome. INTERVENTION(S): NQ, vestibular function tests, hospital anxiety and depression scale (HADS), vestibular rehabilitation benefit questionnaire (VRBQ). MAIN OUTCOME MEASURE(S): Medical records of patients presenting for vestibular assessment from January to December 2017 were retrospectively reviewed. Demographic data, self-reported questionnaire results, HVS diagnosis, vestibular test results, and reported symptoms were recorded. RESULTS: In total, 359 patients presented for vestibular assessment with completed NQ. One hundred thirty nine patients (39%) had a positive (≥24) Nijmegen score. In 34 patients, a diagnosis of hyperventilation syndrome was recorded; 10 of these patients did not have a positive Nijmegen score.There was no significant difference found in either vestibular lesion type or compensation status between patients with positive and negative Nijmegen scores (p > 0.05). Symptoms commonly described by patients with positive Nijmegen scores include "blurred vision," "tingling," "anxiety," "shortness of breath," "palpitations," "panic," "numbness," "chest pain," and "chest tightness." In contrast, when grouped by HVS diagnosis, patients with HVS were significantly more likely to have No Lesion detected on vestibular function testing (p = 0.0366). "Panic," "anxiety," and "tingling" were the only significant symptoms reported more often in the HVS diagnosis group, while "nausea/vomiting" and "vertigo" were reported significantly less frequently compared with the non-HVS diagnosis group. CONCLUSIONS: Hyperventilation is a complex stimulus, with some effects manifesting in neurotology clinics. This study reveals discrepancies in both vestibular assessment findings and symptom profiles between patients with a positive screening score in the NQ and patients clinically diagnosed with hyperventilation syndrome. This data will inform clinicians' interpretation of the NQ in the neurotologic setting.