There is substantial evidence that vestibular rehabilitation is effective in cases of vestibular injury or dysfunction (3, 10), but responses may vary depending on the aetiology (11).
Vestibular rehabilitation is an exercise-based treatment consisting of eye, head and body movements designed to stimulate and optimise vestibular compensation. The goal is to reduce the experience of dizziness and imbalance by re-establishing effective and automatic eye-head coordination, reducing anxiety and self-monitoring, increasing fitness, boosting confidence and learning to live with dizziness. The treatment is suitable for anyone who can perform a daily low-intensity exercise programme for 6–12 weeks. Many patients can do this independently. Others require follow-up by a physiotherapist.
The exercises used to promote recovery begin cautiously and slowly increase in intensity. The exercises consist of head movements (bending backwards and forwards, tilting from shoulder to shoulder and turning to the sides, with eyes open and closed, at rest and while moving the body), eye movements (keeping the eyes fixed in different directions while moving the body), rolling the body from side to side in a lying position, bending the head towards the floor in a sitting position, standing up from a lying position, standing with the legs together, standing on one leg, standing heel-to-toe, and walking in a circle on an uneven surface, combined with head and eye fixation exercises (12).
Some patients may benefit from cognitive behavioural therapy in addition to vestibular rehabilitation (3).
Antiemetic drugs, betahistine and drugs for travel sickness have no place in vestibular rehabilitation, but may instead delay recovery. Such medications should only be used for a brief period in the acute phase of vestibular neuritis to relieve symptoms and increase physical activity (13).