From the Guidelines
Vestibular insufficiency is a condition characterized by a dysfunction of the vestibular system, leading to symptoms such as dizziness, vertigo, imbalance, and difficulty maintaining stable vision during head movements, and its management should prioritize vestibular rehabilitation therapy to promote central vestibular compensation and improve quality of life. This condition can result from various factors, including aging, infections, medication side effects, head trauma, or diseases affecting the inner ear, such as Ménière's disease, as discussed in the clinical practice guideline published in 2020 1. The treatment approach for vestibular insufficiency typically involves a range of physical exercises and maneuvers, collectively known as vestibular rehabilitation therapy (VRT), which aims to promote recovery of function and mitigation of symptoms related to balance disorders. Key components of VRT include:
- Gaze stabilization exercises to improve balance and gait
- Habituation exercises to reduce sensitivity to certain movements
- Balance training to enhance overall stability
- Walking exercises for endurance, as outlined in the study 1. While medications like meclizine or diazepam may be prescribed for short-term symptom relief, they are not recommended for long-term use due to their potential to interfere with the brain's natural compensation process. Lifestyle modifications, such as avoiding sudden movements, staying hydrated, and reducing consumption of alcohol and caffeine, can also play a crucial role in managing symptoms and improving quality of life for individuals with vestibular insufficiency. According to the guideline, clinicians should offer vestibular rehabilitation/physical therapy for patients with chronic imbalance, as it has been shown to have a preponderance of benefit over harm 1.
From the Research
Definition and Symptoms of Vestibular Insufficiency
- Vestibular insufficiency, also known as vestibular hypofunction, refers to a condition where the vestibular system is not functioning properly, leading to symptoms such as dizziness, imbalance, and oscillopsia 2.
- These symptoms can negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work 2.
- Vestibular insufficiency can be caused by various factors, including peripheral or central vestibular disorders, and can be unilateral or bilateral 2, 3.
Diagnosis and Treatment of Vestibular Insufficiency
- Diagnosis of vestibular insufficiency is typically based on objective vestibular function tests 2.
- Treatment for vestibular insufficiency often involves vestibular rehabilitation therapy (VRT), which is an exercise-based treatment program designed to promote vestibular adaptation and substitution 4, 2.
- VRT has been shown to be effective in reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction 2, 5, 6.
- The goals of VRT include enhancing gaze stability, postural stability, improving vertigo, and improving activities of daily living 4.
Exercise-Based Vestibular Rehabilitation
- Exercise-based vestibular rehabilitation typically involves a customized plan of care, including exercises such as head-eye movements, balance exercises, and gaze stabilization exercises 4, 2, 5.
- These exercises can be performed in a clinical setting or at home, and have been shown to be effective in improving symptoms and function in individuals with vestibular insufficiency 2, 5, 6.
- Recent evidence suggests that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction 2.