The role of customized vestibular rehabilitation with visual desensitization in the management of visual vertigo syndrome

Objectives: The objective of this study is to assess the benefits of customized vestibular rehabilitation with visual desensitization in the management of visual vertigo (VV).

Methods: This retrospective study included 65 patients suffering from VV with situational characteristic questionnaire more than 0.9. Patients who did not complete the follow up in the VV clinic were not included in the analysis. Patients underwent customized vestibular rehabilitation using graded and progressive gaze stabilization exercises without background followed by introduction of visual stimulation (e.g. patterned wallpaper) and optokinetic DVD for home training to promote visual desensitization. The Situational Characteristic Questionnaire (SCQ), Hospital Anxiety and Depression Scale (HADS), the Nijmegen Questionnaire and Dizziness Handicap Inventory (DHI) were used to assess patient symptoms before and after the vestibular rehabilitation.

Results: Seventy-five per cent of subjects in the study had statistically significant improvement in the SCQ from 2.31 ± 0.73 to 1.89 ± 0.88 after the rehabilitation. Sixty-three per cent of patients had statistically significant improvement in the Nijmegen questionnaire from 27.03 ± 9.94 to 24.75 ± 11.88 after the rehabilitation. There was statistically insignificant difference in the HADS score from 9.69 ± 4.28 to 9.76 ± 5.21 after the rehabilitation. Although there was improvement in the total DHI score as well (from 53.87 ± 16.289 to 50.10 ± 20.413), this was statistically insignificant. However, there was statistically significant improvement in the DHI some subgroups (physical and functional scores) and statistically non-significant improvement in other subgroups (emotional score and total score). The mean duration of rehabilitation was 6.8 ± 5 months. Correlation analysis between SCQ score and other questionnaire scores after the rehabilitation shows significant positive correlation between the post-rehabilitation SCQ questionnaire and other questionnaires.

Conclusions: Customized vestibular rehabilitation incorporating visual desensitization exercises with optokinetic DVD results in significant improvement in VV symptoms.