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Sponsored by: Jordan Hearing and Balance, LLC South Jordan Utah
Lynn S. Alvord PhD
Vestibular Neuritis and Viral Labrynthitis
The prognosis of vestibular rehabilitation in vestibular neuritis is generally very good. This assumes, however, that the patient has ability to do the exercises properly, which includes good mobility of the head, adequate vision to fixate on small, distinct targets, and no major neurological or musculoskeletal conditions. Research shows that those who participate in vestibular rehabilitation improve at a faster rate than those who don’t. The question of when to start such therapy, however, is still a bit undecided. I prefer to have the patient wait 2-3 weeks before beginning therapy. This has the advantage of avoiding unnecessary therapy for those whose symptoms will resolve spontaneously. Also, the exercises will make a patient’s symptoms somewhat worse in the beginning, which can discourage the patient from doing them at all. Waiting a couple of weeks, results in less feelings of dizziness when eventually beginning the exercises. The down side of waiting is that some patients may be lost to follow-up and just decide on their own that they will have to live with the small amount of vertigo or unsteadiness that they are left with. Some older individuals, who lose the feeling of dizziness due to aging, will not recognized that their balance is still affected by the disorder weeks afterwards. How does a clinician know when a patient has completely compensated? Some lingering headshake nystagmus can occur when a patient is essentially free of vertigo. Neither do lingering abnormal “vestibular balance” scores on Posturography mean that the patient has not compensated to the extent possible, because these scores are obtained mainly in the eyes closed condition. Patients who have compensated completely using the exercises (with eyes open) will often remain very off balance with eyes closed or in the dark. One good way of determine compensation is by using the dynamic visual acuity test, which assesses the patient’s ability to read an eye chart while the head is moving laterally back and forth. If true gaze stabilization has occurred, it should be able to be demonstrated with improved scores on this test (see the testing section for more information on dynamic visual acuity). Again, absence of symptoms alone should not be the only criterion for determining complete compensation.
In addition to vestibular rehabilitation to improve gaze stabilization, which concerns the vestibular ocular reflex, exercises should also be given to address and improve the other major vestibular reflexes (vesitbulocolic and vestibulospinal). The reader is referred to the rehabilitation section for more information.