Vestibular Rehabilitation for Unilateral Peripheral Vestibular Hypofunction

Abstract

Introduction: Unilateral peripheral vestibular hypofunction (UPVH) causes vertigo, postural instability, and oscillopsia. Vestibular rehabilitation therapy (VRT) is recommended but optimal exercise type, frequency, and duration are not standardized. Methods: Systematic review of 12 RCTs (n=956) comparing customized VRT (gaze stabilization, habituation, balance exercises) versus sham exercises or no intervention. Inclusion: acute (<3 months) and chronic (>6 months) UPVH (vestibular neuritis, labyrinthitis, post-surgical). Primary outcome: Dizziness Handicap Inventory (DHI) change at 4 weeks and 12 weeks. Secondary: posturography sway area, gait speed. Results: VRT significantly reduced DHI at 12 weeks (mean difference –18.4 points, 95% CI –24.1 to –12.7) versus control (–4.2). Gaze stabilization exercises improved vestibulo-ocular reflex gain by 0.24 (p=0.002). Chronic patients responded as well as acute but required longer duration (8 vs 4 weeks). No difference between once-daily and twice-daily home exercise. Discussion: Plasticity of the vestibular system persists for years. Home-based VRT with weekly supervision is cost-effective. Conclusion: Customized vestibular rehabilitation significantly improves symptoms and postural control in UPVH regardless of disease duration.