Vestibular Rehabilitation

Vertigo and dizziness treatments include medications, vestibular rehabilitation and rarely surgical treatment. In acute phase of dizziness and vertigo as well as in disorders such as vestibular neuritis, Meniere’s disease and vestibular migraine, medications which focus on reduction of dizziness and vertigo symptoms are used. In this stage, vestibular suppressants such as anticholinergics, antihistamines and benzodiazepines are used. Moreover, in cases like Meniere’s disease and secondary endolymphatic hydrops, the aim of using vestibular suppressants is to decrease the pressure in the endolymphatic system. Usually, in cases of acute dizziness, the patient is unable to move due to severe nystagmus, dizziness and imbalance. Therefore, the vestibular suppressants reduce these symptoms and after a few days, the patient is able to move. After this stage, in most of peripheral vestibular disorders such as vestibular neuritis, bilateral vestibulopathy and BPPV, drug therapy not only does not help the patient, but also delays restoration of (near) normal balance. In fact, in peripheral vestibular disorders in which inner ear or vestibular nerve are damaged, active movements of patient are necessary for central nervous system compensation. Therefore, in a vestibular rehabilitation program which is designed based on patient’s dysfunctions, they perform some exercises to induce vestibular compensation. These balance exercises in the early stages can cause higher degrees of blurred vision (ossilopsia), dizziness, vertigo, and imbalance, but these symptoms will decrease after some weeks as the patient progresses.  Otherwise, the patient never returns to the level of his previous activities, his movements slow down and will avoid difficult activities such as fast running and professional exercises.

Vestibular rehabilitation is an individualized program based on active exercises which is designed and implemented by an audiologist. Type of balance problem and the results of vestibular function tests such as questionnaires, videonyastagmography (VNG), video head-impulse test (vHIT), ocular and cervical vestibular evoked myogenic potentials (cVEMP/oVEMP) are effective factors in this process. The final aim of these exercises is reducing dizziness and improving balance. The duration of vestibular rehabilitation varies from one or more weeks (in BPPV) to several months (in the case of vestibular neuritis) or a few years (in the case of bilateral vestibulopathy).

Vestibular rehabilitation is increasingly becoming a valuable treatment for patients with dizziness, vertigo, and imbalance. Vestibular rehabilitation over the past years has been undertaken in various forms including the group’s exercises performed in the 1940s to the current form in which each patient receives a special rehabilitation treatment program.