Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction

Vestibular RehabilitationDizziness prompts more than seven million doctor visits in the U.S. annually. The Vestibular Disorders Association estimates that 42% of the adult population reports episodes of dizziness or vertigo to their physicians and that in 85% of those cases vestibular dysfunction causes the patient’s problems to be recurrent. When the likely outcome of recurrence is not well-addressed, the occasional dizziness or disequilibrium can lead to injury falls, auto accidents, work accidents, or fear of performing normal activities of daily living. Unilateral peripheral vestibular dysfunction (UPVD) is often involved. UPVD describes disorders that affect only one side of the vestibular system and only that portion of the vestibular system that is outside the brain. Examples of UPVD disorders include benign paroxysmal positional vertigo, vestibular neuritis, labyrinthitis, one-sided Meniere’s disease, or vestibular problems subsequent to surgical procedures such as removal of an acoustic neuroma.

Vestibular rehabilitation enjoys increasing popularity as a treatment option for UPVD. Vestibular rehabilitation may involve desensitization strategies, eye-head coordination exercises, balance and gait enhancements, disease education, coping mechanisms, and canalith repositioning maneuvers. This year, McDonnell and Hillier published an update of a 2007 Cochrane Review on vestibular rehabilitation. Periodic updates of such reviews can prove beneficial for accounting for advancements in medicine and therapy and for including new studies. The 2015 review included 39 comparative studies (75% double-blinded) involving 2,441 participants. They included a broader range of diagnoses than previous reviews, and this is likely the highest-powered review of vestibular rehabilitation in UPVD to date. The authors conclude that there is moderate to strong evidence that vestibular rehabilitation is a safe, effective treatment for UPVD, based on a number of high-quality randomized, controlled trials. Among the more specific findings is the conclusion that for BPPV, canalith repositioning maneuvers alone have a higher cure rate than other aspects of vestibular rehabilitation, in the short term. However, re-positioning maneuvers plus exercise-oriented rehabilitation appear to result in better longer-term functional recovery.