Prehab Vestibular Rehabilitation Therapy (VRT) for Unilateral Vestibular Loss

Timothy C. Hain, MD • Page last modified: October 9, 2021

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.