Vestibular Rehabilitation

Vestibular rehabilitation (VR) is a therapeutic approach prepared specifically for each individual who has a vestibular and balance disorder. VR helps in the treatment of unilateral or bilateral vestibular hypofunction and vestibular problems such as labyrinthitis and vestibular neuronitis. Individuals who have inner ear problems which have not been solved for a long time or have received medical treatment benefit from VR. In addition, VR helps to alleviate the complaints of individuals who have undergone surgery due to vestibular problems. With the VR program, regulative activities are carried out to decrease the duration, intensity, and frequency of vertigo; the symptoms of vertigo; increase independency in daily life activities; and to make it possible for patients to deal with the feelings of dizziness, imbalance, and anxiety, in addition to training patients about this issue and regulating the general conditions. The aim is to increase the life quality of patients.

Persistent Postural-Perceptual Dizziness: Precipitating Conditions, Co-morbidities and Treatment With Cognitive Behavioral Therapy

Persistent postural perceptual dizziness (PPPD) is a common chronic vestibular disorder characterized by persistent vestibular symptoms, including postural instability and non-spinning vertigo, which is aggravated by motion, upright posture and moving or complex visual stimuli. In our review of 198 cases seen over a 5 year period, we have confirmed a number of common precipitating conditions for PPPD, including anxiety disorders and vestibular migraine. Vestibular abnormalities, including a unilateral loss of vestibular hypofunction and isolated otolith abnormalities, were found on investigation in just under half the cases. The use of cognitive behavioral therapy (CBT) as a treatment for PPPD resulted in impressive reductions in anxiety and measures of dizziness over follow up periods of up to 6 months.

Relationship between vestibulo-ocular reflex gain and dizziness handicap inventory score to predict effectiveness of vestibular rehabilitation

Background and Aim: Evaluating the effective­ness of vestibular rehabilitation (VR) in patients with vestibular lesions has always been a challe­nge. The questionnaires that are used for this pur­pose mostly show the degree of vestibular dis­ability rather than providing information about improvement of vestibular dysfunction. This study aimed to evaluate whether video head imp­ulse test (vHIT) that is used for the examination of vestibulo-ocular reflex (VOR), is a useful method for predicting the effectiveness of VR and has a correlation with dizziness handicap inventory (DHI) score. Methods: Participants were 42 patients with unilateral peripheral vestibular hypofunction (UPVH) undergoing VR. Patients were assessed before and after rehabilitation by the vHIT in all ipsilesional and contralesional semicircular can­als (SCCs) and the DHI. The changes in DHI score and VOR gain before and after rehabili­tation, were shown as ΔDHI and ΔVOR and their correlation was evaluated. Results: VOR gain from ipsilesional and contra­lesional SCCs was improved significantly after VR. There was a significant strong negative correlation between ΔVOR gain from ipsile­sional SCCs and ΔDHI score but no significant correlation was found between the ΔDHI score and ΔVOR gain from contralesional SCCs. Conclusion: vHIT test is a useful tool to evaluate the effectiveness of VR. VOR gain is correlated with the DHI score. Therefore, the improvement in vHIT results in all three SCCs after VR may be a good predictor of the degree of improvement in dizziness-related disability. Keywords: Vestibular rehabilitation; follow-up; unilateral vestibular hypofunction; video head impulse test; dizziness handicap inventory

The Role of the Smartphone in the Diagnosis of Vestibular Hypofunction: A Clinical Strategy for Teleconsultation during the COVID-19 Pandemic and Beyond

Introduction Vestibular disorders (VDs) are highly prevalent in primary care. Although in general they comprise conditions that are not life-threatening, they are associated with significant functional and physical disability. However, the current coronavirus disease 2019 (COVID-19) pandemic has imposed limitations on the standard treatment of benign conditions, including VDs. In this context, other resources may aid in the diagnosis and management of patients with VDs. It is well known that teleconsultation and teletreatment are both safe and effective alternatives to manage a variety of conditions, and we maintain that VDs should be among these. Objective To develop a preliminary model of clinical guidelines for the evaluation by teleconsultation of patients with suspected diagnosis of vestibular hypofunction during the COVID-19 pandemic and beyond. Methods A bibliographic review of the diagnostic feasibility in VDs by teleconsultation was carried out in the LILACS, SciELO, MEDLINE, and PubMed databases; books and specialized websites were also consulted. The legal, regulatory, and technical issues involving digital consultations were reviewed. Results We found 6 field studies published between 1990 and 2020 in which the efficiency of teleconsultations was observed in the contexts of epidemics and environmental disorders and disadvantageous geographical conditions. After reviewing them, we proposed a strategy to examine and address vestibular complaints related to vestibular hypofunction. Conclusion The creation of a digital vestibular management algorithm for the identification, counseling, initial intervention, monitoring and targeting of people with possible vestibular hypofunction seems to be feasible, and it will provide a reasonable alternative to in-person evaluations during the COVID-19 pandemic and beyond.

Transient peripheral vestibular hypofunction measured with vestibular short-latency evoked potentials following noise exposure in rats

Exposure to 120 decibel sound pressure level (dB SPL) band-limited noise results in delayed onset latency and reduced vestibular short-latency evoked potential (VsEP) responses. These changes are still present four weeks after noise overstimulation. Noise induced hearing loss (NIHL) has been shown to vary in extent and duration based on noise intensity. This study investigated whether noise-induced peripheral vestibular hypofunction (NPVH) would also decrease in extent and/or duration with less intense noise exposure. In the present study, rats were exposed to a less intense noise (110dB SPL), but for the same duration (6 hours) and frequency range (500-4000 Hz) as used in previous studies. The VsEP was assessed 1, 3, 7, 14, 21, and 28 days after noise exposure. In contrast to 120 dB SPL noise exposure, the 110 dB SPL noise exposures produced smaller deficits in VsEP responses that fully recovered in 62% of animals (13/21) within one week. These findings suggest that NPVH, a loss or attenuation of VsEP responses with a requirement for elevated stimulus intensity to elicit measurable responses, is similar to NIHL, i.e., lower sound levels produce a smaller or transient deficit. These results show it will be important to determine the extent and duration of vestibular hypofunction for different noise exposure conditions and their impact on balance.