People with vestibular problems often experience dizziness and trouble with vision, balance or mobility. The vestibular disorders that are called unilateral and peripheral (UPVD) are those that affect one side of the vestibular system (unilateral) and only the portion of the system that is outside of the brain (peripheral - part of the inner ear). Examples of these disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, one-sided Ménière's disease or vestibular problems following surgical procedures such as labyrinthectomy or removal of an acoustic neuroma. Vestibular rehabilitation for these disorders is becoming increasingly used and involves various movement-based regimes. Components of vestibular rehabilitation may involve learning to bring on the symptoms to 'desensitise' the vestibular system, learning to co-ordinate eye and head movements, improving balance and walking skills, learning about the condition and how to cope or become more active.
We found 27 randomised clinical trials that investigated the use of vestibular rehabilitation in this group of disorders. All studies used a form of vestibular rehabilitation and involved adults who lived in the community with symptomatic, confirmed UPVD. The studies were varied in that they compared vestibular rehabilitation with other forms of management (for example medication, usual care or passive manoeuvres), with control or placebo interventions or with other forms of vestibular rehabilitation. Another source of variation between studies was the use of different outcome measures (for example reports of dizziness, improvements in balance, vision or walking, or ability to participate in daily life). Due to the variation between studies, only limited pooling of data was possible. The results of four studies could be combined, which demonstrated that vestibular rehabilitation was more effective than control or sham interventions in improving subjective reports of dizziness, and in improving participation in life roles. Three studies gave a combined result in favour of vestibular rehabilitation for improving walking. Other single studies all found in favour of vestibular rehabilitation for improvements in areas such as balance, vision and activities of daily living. The exception to these findings was for the specific group of people with BPPV, where comparisons of vestibular rehabilitation with specific physical repositioning manoeuvres showed that these were more effective in dizziness symptom reduction, particularly in the short term. However, other studies demonstrated that combining the manoeuvres with vestibular rehabilitation was effective in improving functional recovery in the longer term. There were no reports of adverse effects following any vestibular rehabilitation, and in the studies with a follow-up assessment (3 to 12 months) positive effects were maintained. There was no evidence that one form of vestibular rehabilitation is superior to another.
There is a growing and consistent body of evidence to support the use of vestibular rehabilitation for people with dizziness and functional loss as a result of UPVD. The studies were generally of moderate to high quality and were varied in their methods.