Vestibular rehabilitation

Despite growing evidence on the effectiveness of vestibular rehabilitation (VR) in several vestibular pathologies, data on its impact in patients with vestibular migraine (VM) remain relatively limited. The aim of this study was to evaluate the effects of VR on balance, dizziness severity, sleep quality and quality of life in patients diagnosed with VM. Forty eight patients diagnosed with VM were randomized into two groups: a control group receiving routine medical treatment and an intervention group receiving medical treatment plus an eight-week structured VR program. Participants were assessed for dizziness severity using a Visual Analog Scale (VAS), for balance using balance tests, for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and for handicap-related quality of life using the Dizziness Handicap Inventory (DHI), at baseline and at the end of the 8-week treatment. A total of 40 VM patients completed the study. The majority of the participants were female (85%). The intervention group showed significant improvements in static and dynamic balance tests, PSQI, dizziness-related DHI, and dizziness severity (VAS) from baseline to post-intervention (p < 0.05), whereas the control group showed no meaningful changes. Repeated measures ANOVA revealed significant group × time interactions across balance, functional mobility (TUG), sleep quality, and dizziness outcomes (p < 0.05), indicating greater improvements in the intervention group compared with controls. An eight-week structured VR program combined with routine medical treatment significantly improved balance, reduced dizziness severity and dizziness-related disability, and enhanced sleep quality in patients with VM.

Objective:To evaluate the efficacy of vestibular rehabilitation in patients with anterior peripheral vertigo and analyze its influencing factors. Methods:From January 2018 to June 2021, 153 cases with peripheral vertigo diseases（including 47 cases of benign positional paroxysmal vertigo, 38 cases of Meniere's disease, 26 cases of sudden deafness with vertigo, 23 cases of vestibular migraine and 19 cases of vestibular neuritis） were enrolled. One hundred and three cases were treated with vestibular rehabilitation combined with drugs, and 50 cases only treated with drugs were used as controls. Self-rating scale and vertigo disorder scale were evaluated at the beginning of treatment, 4 weeks and 8 weeks, respectively. The curative effects of the two groups were tested by t-test, and the independent risk factors affecting the curative effects were analyzed by multiple linear regression. Results:There was no difference in clinical data, self-assessment scale and vertigo disorder scale between the two groups（P>0.05）. At 4 and 8 weeks, the scores of self-assessment scale and vertigo disorder scale in the experimental group were better than those in the control group（all P<0.01）, and the curative effect at 8 weeks was better than that at 4 weeks, especially the decrease of emotional score during walking and the proportion of severe vertigo disability（all P<0.01）. The scores of self-rating scale and vertigo disorder scale of the cases with benign positional paroxysmal vertigo and vestibular neuritis were better than Meniere's disease, vestibular migraine and sudden deafness with vertigo（P<0.05）. Headache（P<0.05） and severe vertigo disorder before intervention（P<0.01） were independent risk factors affecting the efficacy of vestibular rehabilitation. Conclusion:Vestibular rehabilitation combined with anti-vertigo drugs in the treatment of vestibular peripheral vertigo is better than that of only using drugs, especially in improving the degree of emotional disorder and vertigo disability. It is more suitable for benign positional paroxysmal vertigo and vestibular neuritis, while the effect of combined headache or severe vertigo is relatively poor.

Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed. To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018. The total direct medical costs associated with MD, VM, and BPPV. A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast. In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.

The search for possible ways to minimize dizziness in patients with vestibular migraine is especially relevant in the aspect of individualized complex vestibular rehabilitation. Aim. To study the possibilities of complex individualized vestibular rehabilitation in patients with vestibular migraine. Material and methods. The study included 122 patients (40 men and 82 women) aged 18 to 50 years, with significant vestibular migraine. We used the Dizziness Handicap Inventory scale for assessing dizziness and a 5-point Scale for subjective assessment of the severity of dizziness and a special complex method including a set of vestibular exercises, a method of the computer stabilometry with biofeedback. Objective control of vestibular rehabilitation was carried out with the help of stabilometric testing. Results and discussion. Positive dynamics were observed when analyzing the data of the physical, functional and emotional subscales of the Dizziness Handicap Inventory and the Scale of Subjective Assessment of the Dizziness Severity. In addition, the presented stabilometric diagnostics made it possible to fix the difference between the initial condition of patients with vestibular dysfunction and after 3 months of the special vestibular rehabilitation.Тhere was a statistically significant decrease in the basic stabilometric parameters: the area of the statokinesiogram (median area, mm² – 254 (95% CI 222-285)) and the rate of deviation of the center of pressure (median speed, mm/s – 21 (95% CI 17-24)) as well as a decrease in the shifts of the spectrum energy in the low-frequency and high-frequency spectrum that indicates an improvement in stability. The presented method for influencing the compensatorycapabilities of regulatory mechanisms in patients with vestibular migraine positively affects the efficiency of the equilibrium system as a whole, optimizing postural stability in this category of patients. Conclusion. An individually selected comprehensive program of vestibular gymnastics and hardware rehabilitation techniques on the stabilographic platform with biofeedback helps to improve postural stability and minimize dizziness in patients with vestibular migraine.

Perioperative vestibular assessment and testing

Background: The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular...

The Use of Novel Instrumented Socks to Detect Changes in Daily Life Mobility During an Exercise Intervention in Prostate Cancer Survivors Treated with Androgen Deprivation Therapy

Vestibular migraine (VM) is a common migraine subtype characterized by recurrent vestibular symptoms. Despite its prevalence, evidence-based treatment guidelines are lacking. Vestibular rehabilitation (VR) has been proven effective in many vestibular disorders, but its role in managing VM has not been well established. This systematic review aimed to summarize and pool the evidence on the effectiveness of VR for VM using standardized outcome measures, primarily focusing on patient-reported dizziness-related quality-of-life assessments. We systematically searched MEDLINE, Embase, Cochrane Library, and Scopus from inception to March 2025 for studies evaluating self-reported and physical outcome measures of VR in patients with VM. Meta-analysis of mean change in Dizziness Handicap Inventory (DHI) scores was performed. Risk of bias was assessed using the Cochrane RoB 2 tool for the randomized controlled trials and the ROBINS-I tool for observational studies. Seven studies comprising 413 patients (mean age, 45.4; 76% female) with VM treated with VR were included. The effect of vestibular rehabilitation on DHI scores showed a pooled mean difference of -29.3 (95% confidence interval [CI], -40.2 to -18.3), more than the clinically important difference of 18 points. Although, our meta-analysis had high heterogeneity (Cochran's Q p value <0.001, I2 = 94.7%). VR demonstrated a reduction in DHI scores, meeting the clinically significant difference of 18 indicating clinical improvement. However, the considerable heterogeneity limits the generalizability of these results and highlights the need for further standardized randomized controlled trials with subgroup analyses to better determine the specific benefits and optimal protocols of VR in managing VM.

Dizziness/vertigo is one of the most common symptoms for which people seek healthcare. However, the healthcare expenditure attributable to dizziness/vertigo in South Korea remains poorly understood. We investigated the healthcare costs due to six major disorders causing dizziness/vertigo using claims data. The healthcare costs were evaluated using all the claims data submitted to the Health Insurance Review and Assessment Service from January 1 to December 31, 2022. The six major vestibular disorders included for analysis were benign paroxysmal positional vertigo (BPPV), psychogenic/persistent postural perceptual dizziness (PPPD), vascular vertigo/dizziness (VVD), vestibular migraine (VM), Meniere's disease (MD), and vestibular neuritis (VN). During the 1-year study period, 4.1% of adults aged 20 or older visited hospitals due to dizziness/vertigo in South Korea. Compared to the general population, the patients with dizziness/vertigo were more often elderly, female, and residents of small towns. The total healthcare cost for the six major vestibular disorders was ₩547.8 billion (approximately $406.5 million). BPPV incurred the highest annual healthcare cost (₩183.5 billion, 33.5%), followed by VVD (₩158.8 billion, 29.0%), MD (₩82.2 billion, 15.0%), psychogenic/PPPD (₩60.3 billion, 11.0%), VN (₩32.9 billion, 6.0%), and VM (₩30.1 billion, 5.5%). The mean healthcare cost per hospital visit due to dizziness/vertigo was ₩96,524 (95% confidence interval, ₩96,194-₩96,855), 30% higher than the average (₩73,948) of the overall healthcare cost per hospital visit over the same period. Owing to higher healthcare costs for dizziness/vertigo and increased prevalence of dizziness/vertigo in the aged population, healthcare costs due to dizziness/vertigo will increase rapidly in South Korea. Thus, a guideline for cost-effective management of dizziness/vertigo should be established to reduce the healthcare costs due to these common symptoms.

Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients.

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. The most important symptom is vertigo, which is triggered by changes in head position and sometimes is accompanied by vegetative symptoms. Furthermore, etiology may be subcategorized into idiopathic and secondary (connected to other vestibular disorder, like Ménière's disease, vestibular neuritis, or vestibular migraine). Aim: To identify such parameter of ultrasound-computer-craniocorpography (US-COMP-CCG), which could be useful in the differentiation of idiopathic and secondary BPPV. Material and method: 135 patients suffering from BPPV and 140 normal vestibular functioning patients were examined with UC-COMP-CCG. Statistical analysis was completed by using IBM SPSS V24 software. Results: 109 patients suffered from idiopathic BPPV (i-BPPV), and 26 patients from secondary BPPV (s-BPPV). Parameters indicating the imbalance were observed in both the standing test and the stepping test. Respectively, remarkable results were given in the forehead covering and the self-spin parameter. Conclusion: By applying and examining both study groups with US-COMP-CCG, we were able to use modern diagnostics and thus have an objective evaluation based on their properties. The objective results from the US-COMP-CCG parameters show the deterioration of the vestibular system as well as the change in values, based on the cause of BPPV in secondary cases. Orv Hetil. 2020; 161(6): 208-213.

High rates of coexisting vestibular deficits and psychiatric disorders have been reported in patients with vertigo. Hence, a causal linkage between the vestibular system and emotion processing systems has been postulated. The aim of this study was to evaluate the impact of vestibular function and vestibular deficits as well as preexisting psychiatric pathologies on the course of vestibular vertigo syndromes over 1 year. This interdisciplinary prospective longitudinal study included a total of 68 patients with vestibular vertigo syndromes. Four subgroups were compared: benign paroxysmal positioning vertigo (BPPV, n=19), vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), and Menière's disease (MD, n=8). All patients underwent neurological and detailed neurootological examinations as well as two standardized interviews and a psychometric examination battery at five different times (T0-T4) over 1 year. The prevalence of psychiatric disorders at baseline (T0) did not differ between the four subgroups. Only patients with VM showed significantly higher rates of psychiatric disorders (p=0.044) in the follow-up over 1 year. Patients with a positive history of psychiatric disorders before the onset of the vestibular disorder had significantly increased rates of psychiatric disorders compared to patients with a negative history of psychiatric disorders (T1: p=0.004, T3: p=0.015, T4: p=0.012). The extent of vestibular deficit or dysfunction did not have any influence on the further course of the vestibular disease with respect to the development of psychiatric disorders. A positive history of psychiatric disorders is a strong predictor for the development of reactive psychiatric disorders following a vestibular vertigo syndrome. Especially patients with vestibular migraine are at risk of developing somatoform dizziness. The degree of vestibular dysfunction does not correlate with the development of psychiatric disorders.

The diagnosis and treatment of acute vertigo in emergency neurological practice are among the most pressing issues in modern neurology. The diagnosis of vestibular system disorders remains at a low level. Many patients with peripheral vestibular system damage and vestibular migraine are misdiagnosed with stroke and transient ischaemic attacks, chronic vertebrobasilar insufficiency, and cervical osteochondrosis. Acute vestibular vertigo is in most cases associated with pathology of the peripheral vestibular system and vestibular migraine, and much less often with stroke or transient ischaemic attacks in the vertebrobasilar arterial system. To make a diagnosis, it is especially important to conduct a clinical neurovestibular examination, including positional tests for benign paroxysmal positional vertigo, the Halmagyi (head impulse) test, assessment of oblique deviation, severity of trunk ataxia and hearing impairment, as well as the use of modern neuroimaging methods. Modern treatment regimens have been developed for each of the nosological forms. A low-dose combination drug of cinnarizine 20 mg + dimenhydrinate 40 mg in combination with vestibular rehabilitation has shown high efficacy in the treatment of vertigo.

Differences in vestibulo-ocular reflex time constants in patients with vestibular migraine versus vestibular neuritis/labyrinthitis

To derive precise estimates of anxiety and depressive disorder prevalence in patients with common vestibular disorders. CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS. This systematic review and meta-analysis was reported per PRISMA guidelines. Outcomes included continuous measures (mean), proportions (%), and relative risks (RR) with 95% confidence intervals. Eighty-five studies (n = 764,403) examining anxiety, depression, and vestibular disorders in adults were included. Mean ages were 50.3 (vestibular) and 46.7 (control); females comprised 63.8% and 64.3%, respectively. Patients with vestibular disorders had significantly higher rates and risks of anxiety (31.4% vs. 8.3%, p < 0.0001; RR = 1.50, 95% CI: 1.1-2.0) and depression (28.3% vs. 4.7%, p < 0.0001; RR = 2.9, 95% CI: 1.8-4.4) than controls. Elevated rates were observed in benign paroxysmal positional vertigo (30.6%, 23.6%), Meniere's disease (47.0%, 43.1%), vestibular migraine (46.5%, 35.7%), and vestibular neuritis (19.4%, 20.7%) (all p < 0.0001). Episodic disorders showed higher prevalence than vestibular neuritis. Patients with unspecified peripheral vestibular disorders also had significantly higher anxiety (12.1%) and depression (13.2%) rates than controls. Meta-regression revealed significant associations between Dizziness Handicap Inventory (DHI) scores and Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales. This meta-analysis offers the most precise prevalence and relative risk estimates of anxiety and depressive disorders in vestibular illness. The greater risk in episodic versus single-event vestibular disorders may inform the understanding of vestibular-psychiatric comorbidity mechanisms.