Prehab Vestibular Rehabilitation Therapy (VRT) for Unilateral Vestibular Loss

Timothy C. Hain, MD Page last modified: July 14, 2009

Vestibular rehabilitation therapy (VRT) has been generally shown to be helpful in recovery from unilateral loss, such as for vestibular neuritis or acoustic neuroma (Strupp et al. 1998; Herdman et al. 2003; Krebs et al. 2003; Badke et al. 2004; Cohen et al. 2004; Topuz et al. 2004; Hall et al, 2004; Enticott et al, 2005).

It has recently been suggested that "prehab" -- pretreatment with gentamicin and physical therapy, may improve the outcome of surgery for removal of an acoustic neuroma. (Tjernstrom et al, 2009). In this study, six patients were treated with gentamicin prior to trans-labyrinthine schwannoma surgery. There was less sway on "vibratory posturography" 6 months after surgery, compared to patients untreated.

Comment: We are dubious. It seems to us that this process simply "moves" the adaptation, and is unlikely to be accompanied by any long term difference. In particular, we would suspect that 2 year followup will be identical in the same groups. . After nerve section, adaptation is needed to the new sensory situation where there is no vestibular function from one side. This protocol would force patients to undergo some of this prior to surgery. The "improvement" at 6 months may not reflect any long term change, but simply forcing subjects to spread out their dizziness over a longer period of time (pre-treatment plus post-surgery). We are also unsure whether changes in "vibratory posturography" outcomes correlate with any real-world improvement.

Also see the main page on VRT.

References:

• Badke, M. B., et al. (2004). "Outcomes after rehabilitation for adults with balance dysfunction." Arch Phys Med Rehabil 85(2): 227-33.
• Enticott, J. C., J. O'Leary S, et al. (2005). "Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery." Otol Neurotol26(2): 265-9.
• Fujino A and others. Vestibular training for benign paroxysmal positional vertigo. Arch Otolaryngol HNS 1994:120:497-504.
• Hall CD, Schubert MC, Herdman SJ. Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction. Otology and Neurotology, 25: 746-751, 2004
• Herdman, S. J., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-24.
• Horak FB et al. Effects of vestibular rehabilitation on dizziness and imbalance. Otol HNS 1992:106-175
• Jacob RG, Whitney SL, Detweilder A, Shostak G, Furman JM. Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: A pilot study. Anxiety Disorders 15(2001) 131-146.
• Strupp, M., et al. (1998). "Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis." Neurology 51(3): 838-44.
• Tee LH, Chee NWC. Vestibular rehabilitation for the Dizzy Patient. Ann Acad Med Singapore 2005:34:289-94
• Tjernström F, Fransson PA, Kahlon B, Karlberg M, Lindberg S, Siesjö P, Magnusson M. Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function; Journal of Neurology, Neurosurgery, & Psychiatry (JNNP Online) (Jul 2009)
• Topuz, O., et al. (2004). "Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction." Clin Rehabil 18(1): 76-83.