The efficacy and strategy of individualized vestibular rehabilitation in patients with intractable vertigo

Objective: To explore the prognosis of individualized vestibular rehabilitation (VR) in patients with intractable vertigo and work out an effective and normative rehabilitation program. Methods: A total of 35 patients diagnosed with intractable vertigo who visited Eye & ENT Hospital of Fudan University from September 2017 to December 2019 were enrolled. All the participants consisted of 15 males and 20 females, aged from 24 to 71 years old, and underwent an individualized VR. Follow-ups were conducted at 2 and 4 weeks post-rehabilitation. Assessments consisted of self-rating anxiety scale (SAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence sacle (ABC), computerized dynamic posturography (CDP), and video-electronystagmograph (VNG) were performed. Results: SAS, DHI, ABC scores gradually improved after VR. The scores of SAS scale of pre-VR, 2 and 4 weeks post-VR were 41±8, 37±8 and 36±8, respectively. The scores of DHI were 56(40, 78), 46(22, 74), 16(6, 76), respectively. Meanwhile, the scores of ABC were 80±17, 87±11 and 91±9, respectively. There were significant statistical differences of aforementioned three scale scores at different time points (P=0.020, P 0.05). No interactive effects were revealed among age, gender and time (all P>0.05). The improvement of vestibular function to control balance was statistically significant after 2-and 4-week rehabilitation (both P<0.001). The value of directional preponderance was significantly improved after 4-week VR (P=0.007), while no obvious improvement was found after 2 weeks treatment (P=0.593). There was a statistically significant difference in the value of unilateral weakness (UW) between pre-VR and post-VR since 2 weeks (P=0.001). Conclusion: Individualized VR in patients with intractable vertigo can not only eliminate anxiety, control dizziness, increase activities of daily life, but also improve the function of vestibulo-spinal and vestibulo-ocular reflex pathways.