From the Guidelines
Peripheral vestibulopathy treatment should prioritize vestibular rehabilitation therapy and canalith repositioning maneuvers, with a focus on promoting central compensation and avoiding unnecessary medication use, as supported by recent guidelines 1. The treatment of peripheral vestibulopathy, a disorder affecting the vestibular system in the inner ear, should be approached with a focus on minimizing morbidity, mortality, and improving quality of life.
Key Considerations
- Vestibular suppressants like meclizine or diazepam should be used sparingly, if at all, due to the potential for delaying compensation 1.
- Vestibular rehabilitation therapy, including gaze stabilization exercises, balance training, and habituation exercises, is essential for long-term recovery and should be started as soon as tolerable 1.
- Canalith repositioning maneuvers, such as the Epley maneuver, are highly effective for treating benign paroxysmal positional vertigo (BPPV), a common type of peripheral vestibulopathy 1.
- Patients should maintain good hydration, avoid sudden head movements during acute episodes, and gradually increase activity as symptoms improve to promote central compensation.
- For specific conditions like vestibular neuritis, a short course of corticosteroids may be beneficial if started within 72 hours, but this should be determined on a case-by-case basis.
Treatment Approach
- Initial treatment should focus on symptom management and promoting central compensation, rather than relying on medication.
- Vestibular rehabilitation therapy should be started as soon as possible, with the goal of improving balance and reducing symptoms.
- Canalith repositioning maneuvers should be performed as needed, with repeat maneuvers considered for treatment failures.
- Patients should be reassessed regularly to monitor progress and adjust treatment as needed, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults.
Meclizine is used to treat vertigo associated with diseases affecting the vestibular system, which includes peripheral vestibulopathy. The drug label directly supports the use of meclizine for this condition, as it is indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults 2.
From the Research
Definition and Symptoms of Peripheral Vestibulopathy
- Peripheral vestibulopathy refers to a disorder of the peripheral vestibular system, which is responsible for balance and equilibrium 3.
- Symptoms of peripheral vestibulopathy include dizziness, imbalance, and oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation 4.
Treatment and Rehabilitation of Peripheral Vestibulopathy
- Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution 5.
- The goals of VRT are to enhance gaze stability, postural stability, improve vertigo, and improve activities of daily living 5.
- Exercise-based vestibular rehabilitation has been shown to be effective in improving symptoms of dizziness, balance, and emotional status in adult patients with chronic dizziness 6.
- Clinical practice guidelines recommend offering vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit 4.
Effectiveness of Vestibular Rehabilitation Interventions
- Studies have shown that vestibular rehabilitation interventions, including adaptation, substitution, and habituation, are effective in treating unilateral peripheral vestibular hypofunction 7.
- The effectiveness of vestibular rehabilitation interventions can be measured using outcome measures such as the dynamic gait index and dizziness handicap inventory 7.
- Vestibular physical therapy has been shown to provide a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction 4.
Key Exercises and Techniques for Vestibular Rehabilitation
- Key exercises for VRT include head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk 5.
- Virtual reality and other technologies are being used more frequently to augment vestibular rehabilitation 3.
- Supervised vestibular rehabilitation has been shown to be effective in improving symptoms and functional outcomes 4.