Cochrane: 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, and learning about
the condition and how to cope or become more active.
Study characteristics
We found 39 randomised controlled trials (involving 2441
participants) 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).
Key results
Due to the variation between studies, only limited pooling (combining) 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. Two 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
manoeuvres 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. 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.
Quality of the evidence
The studies were generally of moderate to high quality but were
varied in their methods. This evidence is up to date to 18 January 2014.
- See more at:
http://summaries.cochrane.org/CD005397/ENT_vestibular-rehabilitation-to-improve-dizziness-balance-and-mobility-in-patients-with-unilateral-peripheral-vestibular-dysfunction#sthash.QjIn5x7A.dpuf