g. Treatment »
TREATMENTS

-  -  Patient counseling
-  -  -  Explaining basic vestibular physiology to a patient
NA NA NA NA 4 4 4 4
-  -  -  Explaining a vestibular diagnosis to a patient
NA NA NA NA 4 4 4 4
-  -  -  Explaning the close connection between the vestibular and limbic system to a patient
NA NA NA NA 4 4 4 4
-  -  -  Explaining the vestibular results to a patient taking into account the limitations
NA NA NA NA 4 4 4 4
-  -  -  Explaining audiometric results to a patient taking into account the limitations
NA NA NA NA 2 4 4 2
-  -  -  Explaining the importance of remaining physically active and the concept of compensation
NA NA NA NA 4 4 4 4
-  -  -  Explaining the use of diaries / apps / questionnaires to record symptomatology
NA NA NA NA 3 3 3 4
-  -  -  Involving the patient in the treatment decisions
NA NA NA NA 4 4 4 4
-  -  -  Counseling on stress management, life style management, sleep hygiene
NA NA NA NA 3 3 3 3
-  - 

Open Access: Yes


Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK. Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg. 1995 Jul;113(1):77-87. doi: 10.1016/s0194-5998(95)70148-6. PMID: 7603726.

Link
https://pubmed.ncbi.nlm.nih.gov/7603726/

Keywords
surgical; rehabilitation

Topics

Open Access: Yes


Pavlou M, Lingeswaran A, Davies RA, Gresty MA, Bronstein AM. Simulator based rehabilitation in refractory dizziness. J Neurol. 2004 Aug;251(8):983-95. doi: 10.1007/s00415-004-0476-2. PMID: 15316804.

Link
https://pubmed.ncbi.nlm.nih.gov/15316804/

Keywords
failed vestibular rehabilitation; 3PD

Topics

Open Access: Yes


Ibrahim NMK, Hazza NMA, Yaseen DM, Galal EM. Effect of vestibular rehabilitation games in patients with persistent postural perceptual dizziness and its relation to anxiety and depression: prospective study. Eur Arch Otorhinolaryngol. 2024 Jun;281(6):2861-2869. doi: 10.1007/s00405-023-08369-z. Epub 2023 Dec 21. PMID: 38127098; PMCID: PMC11065905.

Link
https://pubmed.ncbi.nlm.nih.gov/38127098/

Keywords
rehabilitation; 3PD

Topics

Open Access: Yes


Pavlou M. The use of optokinetic stimulation in vestibular rehabilitation. J Neurol Phys Ther. 2010 Jun;34(2):105-10. doi: 10.1097/NPT.0b013e3181dde6bf. PMID: 20588097.

Link
https://pubmed.ncbi.nlm.nih.gov/20588097/

Keywords
rehabilitation; visual vertigo

Topics

Open Access: Yes


McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;1(1):CD005397. doi: 10.1002/14651858.CD005397.pub4. PMID: 25581507; PMCID: PMC11259236.

Link
https://pubmed.ncbi.nlm.nih.gov/25581507/

Topics

Open Access: Yes


Whitney SL, Alghwiri A, Alghadir A. Physical therapy for persons with vestibular disorders. Curr Opin Neurol. 2015 Feb;28(1):61-8. doi: 10.1097/WCO.0000000000000162. PMID: 25514252.

Link
https://pubmed.ncbi.nlm.nih.gov/25514252/

Keywords
rehabilitation

Topics

Open Access: Yes


McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev. 2015 Jan 13;1(1):CD005397. doi: 10.1002/14651858.CD005397.pub4. PMID: 25581507; PMCID: PMC11259236.

Link
https://pubmed.ncbi.nlm.nih.gov/25581507/

Keywords
chronic unilateral

Topics

Open Access: Yes


Lacour M, Tardivet L, Thiry A. Posture Deficits and Recovery After Unilateral Vestibular Loss: Early Rehabilitation and Degree of Hypofunction Matter. Front Hum Neurosci. 2022 Feb 4;15:776970. doi: 10.3389/fnhum.2021.776970. PMID: 35185493; PMCID: PMC8855301.

Link
https://pubmed.ncbi.nlm.nih.gov/35185493/

Keywords
rehabilitation

Topics

Open Access: Yes


Hall CD, Herdman SJ, Whitney SL, Anson ER, Carender WJ, Hoppes CW, Cass SP, Christy JB, Cohen HS, Fife TD, Furman JM, Shepard NT, Clendaniel RA, Dishman JD, Goebel JA, Meldrum D, Ryan C, Wallace RL, Woodward NJ. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022 Apr 1;46(2):118-177. doi: 10.1097/NPT.0000000000000382. PMID: 34864777; PMCID: PMC8920012.

Link
https://pubmed.ncbi.nlm.nih.gov/34864777/

Keywords
rehabilitation

Topics

Open Access: Yes


Michel L, Laurent T, Alain T. Rehabilitation of dynamic visual acuity in patients with unilateral vestibular hypofunction: earlier is better. Eur Arch Otorhinolaryngol. 2020 Jan;277(1):103-113. doi: 10.1007/s00405-019-05690-4. Epub 2019 Oct 21. PMID: 31637477.

Link
https://pubmed.ncbi.nlm.nih.gov/31637477/

Keywords
rehabilitation

Topics
-  -  -  Exploring patient beliefs, behavior management, motivational interviewing (empowerment/engagement skills)
NA NA NA NA 3 3 3 3
-  -  -  Physiotherapy evaluation and goal setting (realistic, limitations)
4 4 4 4 2 2 2 4
-  -  -  Establishing a treatment plan
2 2 2 4 1 1 1 4
-  -  -  Understanding indications for multidisciplinary interventions
4 4 4 4 NA NA NA NA
-  -  -  Use of exercises (head movement, eye movement, balance …)
3 3 3 4 2 2 2 4
-  -  -  Use of devices (mats, wobble board, platforms …)
3 3 3 4 1 1 1 4
-  -  -  Use of virtual reality
2 2 2 4 1 1 1 4
-  -  -  Use of diaries / apps / questionnaires as measures of subjective function
4 4 4 4 3 3 3 4
-  -  -  Awareness that vestibular reflex parameters are poor functional outcome measures
4 4 4 2 NA NA NA NA
-  -  -  Awareness of the emotional aspects
4 4 4 4 NA NA NA NA
-  -  -  Awareness of possible polymorbidity
4 4 4 4 NA NA NA NA
-  -  -  Explaining the rationale for exercise and role of exercise in healing
NA NA NA NA 4 4 4 4
-  -  -  Use of outcome measures
3 3 3 4 3 3 3 4
-  -  -  Management of BPPV (manoeuvers have to be made according to the exact topological diagnosis)
-  -  -  -  Management of posterior canal BPPV
4 4 4 4 4 4 4 4
-  -  -  -  Management of lateral canal geotropic nystagmus variant
4 4 4 4 3 3 3 4
-  -  -  -  Management of lateral canal apogeotropic nystagmus variant
4 4 4 4 3 3 3 4
-  -  -  -  Management of other BPPV variants (including multicanal)
3 3 4 4 2 2 2 4
-  -  -  -  Ability to select most appropriate maneuver amongst those available for the various BPPV types
3 3 4 4 2 2 2 4
-  -  -  -  Awareness and recognition of the complication of canal conversion
4 4 4 4 4 4 4 4
-  -  -  -  Use of aids (e.g. BPPV chair, mastoid vibration)
2 2 4 4 2 2 2 4
-  -  -  -  Teaching of self-maneuvres on indication
0 0 0 4 3 3 3 4
-  -  -  Management of acute unilateral vestibulopathy
3 3 3 4 2 2 2 4
-  -  -  Management of chronic unilateral hypofunction
3 3 4 4 2 2 2 4
-  -  -  Management of bilateral vestibulopathy
3 3 4 4 2 2 2 4
-  -  -  Management of visual vertigo / dizziness
3 3 4 4 2 2 2 4
-  -  -  Management of functional disorders including PPPD
3 3 4 4 2 2 2 4
-  -  -  Management of motion sickness disorder
NG NG NG NG NG NG NG NG
-  -  -  Management of mal de debarquement syndrome
NG NG NG NG NG NG NG NG
-  -  -  Management of ataxia
2 2 4 4 1 1 1 4
-  -  -  Management of posttraumatic vertigo (excluding BPPV)
NG NG NG NG NG NG NG NG
-  -  -  Management of perisurgical vertigo / dizziness
2 3 3 4 2 2 2 4
-  -  -  Management of orthostatic hypotension
4 3 3 4 2 2 2 4
-  -  -  Teaching of use of aids (walking sticks, frames …)
2 2 2 4 2 2 2 4
-  -  -  Advice on safe environments
2 2 2 4 2 2 2 4
-  -  -  Advice on self-management of spontaneous vestibular attacks
2 2 2 2 2 2 2 2
-  -  -  Advice on self-management of panic attacks (including hyperventilation)
3 3 3 3 2 2 2 3
-  -  Orthoptic treatments
-  -  -  Treatment of vergence disorders
2 2 2 2 1 1 1 4
-  -  -  Treatment of oculomotor palsies
2 1 1 2 1 1 1 2
-  -  -  Use of prisms
2 2 2 2 1 1 1 2
-  -  Pharmacotherapy
-  -  -  Vertigo attack, symptomatic relief
4 4 4 2 4 4 1 NA
-  -  -  Acute unilateral vestibulopathy / neuritis
4 4 4 2 4 4 1 NA
-  -  -  Vestibular migraine prophylaxis
4 4 4 2 4 3 1 NA
-  -  -  Migraine headache, attacks and prophylaxis
4 3 3 2 4 3 1 NA
-  -  -  Menière's disease prophylaxis
4 4 4 2 2 3 1 NA
-  -  -  Vestibular paroxysmia
4 4 4 2 4 3 1 NA
-  -  -  Episodic ataxia
4 3 4 2 3 2 1 NA
-  -  -  Motion sickness
4 4 4 2 4 4 1 NA
-  -  -  Motion sickness disorder
NG NG NG NG NG NG NG NG
-  -  -  Mal de Débarquement Syndrome
NG NG NG NG NG NG NG NG
-  -  -  Ocular instabilities (upbeat nystagmus, downbeat nystagmus, pendular nystagmus, periodic alternating nystagmus, ocular flutter, etc.)
3 3 3 2 3 2 1 NA
-  -  -  Treatment of anxiety and depression
4 4 4 2 3 2 1 NA
-  -  -  Treatment of functional disorders including PPPD
3 3 3 2 3 3 1 NA
-  -  -  Inner ear diseases related to auto-immunity
2 2 2 2 2 2 1 NA
-  -  -  Awareness of the effect of pharmacotherapy on vestibular compensation
4 4 4 4 NA NA NA NA
-  -  Psychotherapy
-  -  -  Psychoeducation about anxiety response and vertigo / dizziness
2 2 3 2 1 1 1 2
-  -  -  Psychoeducation about natural body sway and perception
2 2 3 4 1 1 1 4
-  -  -  Psychoeducation about depersonalisation / derealisation symptoms related to vestibular disorders
2 2 3 2 1 1 1 2
-  -  -  Psychoeducation about fear of falling and social embarrassment
2 2 3 3 1 1 1 4
-  -  -  Psychoeducation about avoidance
2 2 3 3 1 1 1 3
-  -  -  Psychoeducation about associations between thoughts, moods
2 2 3 2 1 1 1 2
-  -  -  Cognitive behavioural therapy related to vestibular symptoms
2 2 2 2 1 1 1 2
-  -  -  Breathing control in the vestibular context
2 2 3 3 1 1 1 3
-  -  -  Use of virtual reality
2 2 2 3 1 1 1 4
-  -  Surgery
-  -  -  Neuro-otological surgical procedures (limitations, indications, procedure, complications)
-  -  -  -  Myringomoty tube placement
2 4 3 2 NA 2 NA NA
-  -  -  -  Intratympanic injections of corticosteroids and gentamicin
3 4 3 3 NA 2 NA NA
-  -  -  -  Semicircular canal plugging (middle fossa, transmastoid)
2 4 3 2 0 1 0 0
-  -  -  -  Resurfacing of semicircular canal (middle fossa, transmastoid)
2 4 3 2 NA 1 NA NA
-  -  -  -  Combination of semicircular canal plugging and resurfacing (middle fossa, transmastoid)
2 4 3 2 NA 1 NA NA
-  -  -  -  Round window reinforcement
2 4 3 2 NA 1 NA NA
-  -  -  -  Exploratory tympanotomy for repair of perilymphatic fistula
2 4 3 2 NA 1 NA NA
-  -  -  -  Labyrinthectomy
3 4 3 2 NA 1 NA NA
-  -  -  -  Neurectomy (vestibular nerve neurectomy, singular nerve neurectomy)
3 4 3 2 NA 1 NA NA
-  -  -  -  Surgery for vestibular schwannoma and other cerebellopontine lesions (retrosigmoidal, translabyrinthine, middle fossa, retrolabyrinthine)
2 4 2 2 NA 1 NA NA
-  -  -  -  Surgery for neurovascular compression of the 8th cranial nerve (e.g. Janetta)
2 3 2 2 NA 1 NA NA
-  -  -  -  Surgery of the endolymphatic sac system (sac decompression, shunt, endolymphatic duct blockage)
1 4 2 2 NA 1 NA NA
-  -  -  -  Awareness of vestibular complications of neurosurgical procedures
3 3 3 3 NA NA NA NA
-  -  -  -  Auditory brainstem implants
1 2 2 1 NA NA NA NA
-  -  -  Common otological procedures
-  -  -  -  Cholesteatoma surgery (tympanoplasty, combined approach tympanoplasty, radical cavity, subtotal petrosectomy)
2 4 3 1 NA 1 NA NA
-  -  -  -  Cochlear implant surgery
2 4 3 1 NA 1 NA NA
-  -  -  -  Middle ear implants (e.g. stapedotomy)
2 4 3 1 NA 1 NA NA
-  -  Radiotherapy (limitations, indications, procedure, complications)
-  -  -  Radiotherapy for vestibular schwannoma
2 3 2 3 NA NA NA NA
-  -  Vascular procedures
-  -  -  Stenting
2 1 1 1 1 NA NA NA
-  -  -  Intravenous and intra-arterial thrombolysis
3 1 1 1 1 NA NA NA
-  -  -  Thrombectomy
3 1 1 1 1 NA NA NA
-  -  -  Coiling
2 1 1 1 1 NA NA NA
-  -  -  Obliteration of vascular malformations
2 1 1 1 1 NA NA NA
-  -  -  Vascular surgical interventions
2 1 1 1 1 NA NA NA
-  -  Pediatric aspects
-  -  -  Liaison with educational providers (schools, etc.)
1 1 2 2 1 1 2 2

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Secretariat: Åsa Eriksson - Department of Otorhinolaryngology - Head & Neck Surgery
University Hospital (Akademiska Sjukhuset) SE-751 85 Uppsala, Sweden - Phone +46 18 611 53 65 - E-mail asa.eriksson@akademiska.se