Hearing improvement in attacks of Meniere's disease treated with pressure chamber

A method to reduce endolymphatic pressure by exposing patients with Meniere's disease to underpressure has earlier been described. In this work the possible mechanisms are discussed. A material of 36 patients with acute attacks, treated in this way, is now presented. 15 out of these patients experienced a rapid hearing improvement. In 11 cases the remission has lasted for more than 1 year. The method seems to be of great value for those who improved, since at least an early permanent damage to the cochlea can be avoided.

Treatment of Meniere’s disease with the low-pressure pulse generator (Meniett device)

Until recently, surgery was the only treatment option for people with disabling Meniere's disease that did not respond to adequate medical therapy. A new intermediate level treatment modality, the Meniett device, which applies low-pressure micropulses to the inner ear, has now been shown to be safe and effective. The device is portable and self-administered, requiring a 5-min three-times daily application for an indefinite period. Placement of a tympanostomy tube in the ear drum of the affected ear is necessary. Patient acceptance has been high. Long-term success in control of vertigo is over 80%. Although hearing loss is not improved, Meniett device usage does not adversely affect balance, as do most forms of surgical therapy. Use of the device does not preclude later surgical therapy.

Vestibular rehabilitation using the Nintendo® Wii Balance Board -- a user-friendly alternative for central nervous compensation

CONCLUSION

The Nintendo® Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible.

OBJECTIVE

This cohort study was designed to investigate the impact of the Nintendo® Wii Balance Board as a visual compensation device after acute vestibular neuritis.

METHODS

Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo® Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks.

RESULTS

The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzel's goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05).

Meniett therapy may avoid vestibular neurectomy in disabling Meniere's disease

CONCLUSION

In those patients for whom vestibular neurectomy has been selected due to the disabling recurrence of vertigo spells, Meniett therapy has been shown to allow avoidance of this surgical procedure in a fairly high percentage of patients with Meniere's disease (MD). Our data would also support a better result when pressure treatment is acting on MD of short duration.

OBJECTIVE

To test the possibility that low pressure treatment (Meniett) could avoid vestibular neurectomy in patients with MD that was refractory to medical treatment.

PATIENTS AND METHODS

The setting was a tertiary referral centre in a university hospital. Thirty-six MD patients, for whom vestibular neurectomy was indicated, underwent Meniett treatment and composed a group in which a long-term (>2 years) follow-up was achieved. Additionally, different durations of MD ('young' and 'old' MD) were distinguished and analysed separately.

RESULTS

Twenty-five patients (69.4%) were treated satisfactorily by using Meniett treatment and therefore avoided vestibular neurectomy. In half of them only one cycle of treatment was necessary.

Long-Term Disability of Class A Patients With M??ni??re???s Disease After Treatment With Intratympanic Gentamicin

OBJECTIVE

The main objective of this study was to characterize the residual vestibular symptoms and disability in patients with Ménière's disease who had achieved complete control of vertigo through intratympanic gentamicin treatment. Furthermore, we assessed whether the Functional Level Score prior to treatment reflected the posttreatment symptoms and disability.

STUDY DESIGN

Prospective.

SETTING

Tertiary medical center.

PATIENTS

This study involved 103 patients with Ménière's disease treated with intratympanic gentamicin who, after a long-term follow up, have not suffered new vertigo spells and were not subject to any major modification in their treatment.

METHODS

At inclusion and at the last follow-up visit after a minimum of 3 years of ending the treatment, the clinical status (number of vertigo spells), the unsteadiness as well as the disability produced by the disease, symptoms of anxiety, and compensation were asked using specific questionnaires. The results before and after treatment were analyzed using nonparametric tests.

RESULTS

After a 5-year follow-up, complete control of vertigo was obtained in 81% of the patients with Ménière's disease who were treated with intratympanic gentamicin. Of them, 15.5% still complained of unsteadiness. A functional level of 6 or unsteadiness after treatment are related with a nonreduction in disability after long-term control of vertigo spells.

CONCLUSIONS

The efficacy of gentamicin administered intratympanically is high after long-term follow-up as shown by the disappearance of vertigo spells and by the reduction in disability, increase in perception of quality of life, and reduction in anxiety related to vestibular symptoms. Unsteadiness, although an infrequent complaint, determines a level of almost similar severity in those issues. Special care must be taken with patients with a Functional Level Scale score of 6 at the time of beginning treatment.

Meniett Clinical Trial: Long-term Follow-up

OBJECTIVE

To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment.

DESIGN

A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease.

SETTING

Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone.

PARTICIPANTS

Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use.

INTERVENTIONS

Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed.

MAIN OUTCOME MEASURES

Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence.

RESULTS

Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up.

CONCLUSIONS

Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.

Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial

OBJECTIVE

This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease.

METHODS

Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months.

RESULTS

At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome.

CONCLUSIONS

Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Selected complex auditory disorders

This article provides an overview of four auditory disorders relevant generally to adults and especially to veterans. The disorders are noise-induced hearing loss, idiopathic sudden sensorineural hearing loss, otosclerosis, and Méniàre's disease. Sensorineural hearing loss characterizes each, but additional aspects vary with each of the four conditions. This article describes the conditions, discusses their diagnoses and treatments, and outlines current and suggested rehabilitation. The emphasis is on recent advances, some of which await confirmation prior to possible acceptance as standard practice.

Improvement of postural control in patients with peripheral vestibulopathy

We present here the results of a short-term prospective study on a group of 37 patients with persistent unsteadiness. The treatment of these patients was customized according to the results of the Sensory Organization Test carried out using computerized dynamic posturography. A 5-week period of instrumental rehabilitation was established involving visual biofeedback-based computerized balance intervention that manipulated the individuals' capacities, the goals of the tasks and the environmental context. Exercises were performed twice weekly. This adaptation of the treatment was based on the hypothesis that it would reduce the level of disability and handicap associated with the unsteadiness suffered by these patients. Of the patients, 73% improved their status according to the DHI results. Furthermore, in the group of patients that showed an improvement in the DHI, their SOT composite score increased significantly, their reaction time reduced and their sway velocity, endpoint excursion, maximum excursion and directional control all increased. However, for those patients who did not experience a significant improvement or who recorded an increase in the total DHI score, the modifications in the SOT and LOS tests were not significant.

The role of vestibular rehabilitation in the treatment of Meniere's disease

OBJECTIVE

To study the role of vestibular rehabilitation is treating patients with Meniere's disease.

METHODS

We examined all Meniere's patients presenting to our tertiary care specialized vestibular clinic during a 1-year period. All patients underwent a standardized history and physical examination, a complete auditory-vestibular test battery, and a set of physical therapy tools to measure balance function.

RESULTS

A subset of patients suffered from disequilibrium or unsteadiness between attacks. Once the acute fluctuating symptoms of Meniere's were controlled in this group of individuals, all of them underwent vestibular physical therapy and demonstrated significant improvement in balance function on both objective and self-report tests.

CONCLUSIONS

Due to the fluctuating nature of the disorder, vestibular physical therapy has had a limited role in the treatment of Meniere's disease. In general, rehabilitation has been used only as a postoperative treatment for the acute vertigo seen after vestibular neurectomy or labyrinthectomy. This is the first report advocating the role of vestibular physical therapy in a group of patients receiving medical therapy of intraear medicines (other that gentamicin).

Factors influencing quality of life in patients with Ménière's disease, identified by a multidimensional approach

PURPOSE

To evaluate self-reported quality of life in Ménière's disease patients by a multidimensional approach and to identify predictors of the results.

STUDY DESIGN

Cross-sectional.

SETTING

Tertiary referral hospital centers.

PATIENTS

One hundred-twelve patients with Ménière's Disease.

MAIN OUTCOME MEASURE

Questionnaires concerning quality of life: Short Form 12 (SF-12) including the Mental Component Summary (MCS-12) and the Physical Component Summary (PCS-12), Hospital Anxiety and Depression Scale (HAD), Sickness Impact Profile (SIP), the Function Level Scale (FLS) from the American Association of Otology's criteria for reporting results of treatment of Ménière's Disease, Vertigo Symptom Scale (VSS), Hearing Disability Handicap scale (HDHS), Tinnitus Severity Questionnaire (TSQ), and Sense of Coherence (SOC) Scale.

RESULTS

The Ménière's patients rated their quality of life significantly worse than did healthy reference groups in both the physical and the psychosocial dimensions. The SOC affected the results of the HAD, the MCS-12, and the psychosocial dimension of the SIP. The VSS affected the results of PCS-12, both dimensions of the SIP, and the FLS. The speech perception subscale of the HDHS affected the MCS-12, and tinnitus severity affected the HAD anxiety subscale. The results of the FLS correlated with the physical dimension of quality of life.

CONCLUSION

The Ménière's patients experienced a worse quality of life than did healthy subjects. Vertigo mainly influenced the physical dimension, whereas tinnitus and hearing loss influenced the psychosocial dimension. Sense of coherence had an impact on the psychosocial dimension. The FLS was not sensitive enough to serve as an outcome of treatment results but needed to be complemented by quality of life instruments.

Medical management of Meniere's disease

Medical therapy of Meniere's disease is geared not only toward the differential diagnosis that has led to Meniere's disease and the supportive therapy for the physical manifestations of the disease but also for the psychologic sequelae of the disease such as mild-to-moderate situational depression and even chronic depression. Overall, with adequate medical therapy, allergy workup, and immunotherapy for patients with known diagnoses of allergies, the author's clinic has been able to help more than 85% of its patients who present with symptoms of Meniere's disease. For intractable cases where autoimmune phenomena can be suspected with a strong degree of suspicion, the author's clinic has also treated patients with immunosuppressive medications such as azathioprine and/or methotrexate in a low dose.

Early vestibular rehabilitation in patients with Meniere's disease

This article proposes a broadened definition of vestibular rehabilitation to include patients with active, fluctuating Meniere's disease. Pedagogy in the program shifts from amelioration of symptoms by vestibular adaptation or habituation to education, prevention, and self-empowerment. Recommendations are given for patient education, prevention, and examination.

Visuo-vestibular biofeedback in patients with peripheral vestibular disorders

It is well known that diseases of the vestibular system can be compensated by increased spontaneous activity of other systems engaged in maintaining equilibrium, i.e. proprioceptive and visual systems. A complex approach using multisensory stimulation is the optimal way to achieve vestibular compensation. The aim of our study was to determine the effect of vestibular rehabilitation therapy as measured by posturography in a group of 72 patients suffering from vestibular disorders: Ménière's disease (n = 31), neuritis vestibularis (n = 21) and vertebrobasilar insufficiency (n = 20). Patients underwent the following examinations: electronystagmography; caloric, rotatory and optokinetic tests; computed posturography; craniocorpography; pure-tone audiometry; speech audiometry; and tinnitometry (tinnitus loudness, pitch). The instability in patients with Ménière's disease decreased 3 weeks after starting the therapy; nevertheless, the decrease in area (the surface formed by the movement of the patient's equilibrium point during a defined time) was transitory because of the increase in area values obtained between the 3rd and 6th weeks when measured with closed eyes. In the vestibular neuronitis patients, the measured values of area and the velocity of the patient's movement decreased continuously. The values measured in the patients suffering from vertebrobasilar insufficiency decreased continuously, the absolute values remaining pathological.

Streptomycin perfusion of the labyrinth in the treatment of Menière's disease: a modified technique

The ideal surgical procedure for Menière's disease would combine the high rate of vertigo control and the good hearing preservation of vestibular nerve section with the low morbidity of labyrinthectomy. Shea's technique of streptomycin perfusion of the labyrinth has been modified by making an additional opening into the posterior semicircular canal in an effort to limit the amount of streptomycin going into the cochlea. Seventeen patients with definite Menière's with poor hearing have had this procedure. Vertigo was controlled in 94% and the hearing preserved in 55%. Vestibular rehabilitation was not a problem. It is speculated that hearing preservation would be better if the procedure were not restricted to those with poor hearing. This method of destruction of the vestibular system carries the possibility of hearing preservation and maintains the possibility of cochlear implantation should this ever be required.

Deafness and vertigo

This review follows closely on the publication of significant handbooks and symposia concerned with neuro-otology, pharmacology of emesis, imaging, cochlear prostheses and aspects of vertigo which reflect the considerable advances that have been made in clinical and basic neuroscience in these areas in recent years. The value of the cochlear prosthesis has been demonstrated convincingly and may well be a model for the future of brain implantations in diverse disorders of the central nervous system. Imaging of the inner ear has made spectacular advances to provide invaluable aids to diagnosis. Neuro-otologists are becoming aware of the diversity of diseases, particularly those related to hormonal regulation, which may cause or exacerbate symptoms in patients with vertigo. Fortunately for the sufferer, a clearly focussed view is emerging of the pharmacology of overlapping and interrelated problems of emesis, vertigo and migraine which promises an early solution to their integrated management.

The Epley maneuver for the treatment of benign paroxysmal positional vertigo

In recent years, different forms of physical therapy have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV). These mainly consist of maneuvers aiming to reposition and disperse free-floating endolymph particles in the posterior semicircular canal. We report our experience with one of these procedures, the Epley maneuver (EM), in treating 30 cases of BPPV. Twenty-six patients (87%) were cured, while four (13%) did not respond to treatment. These results are similar to those reported in the literature for the EM and the Semont maneuver.

Vestibular rehabilitation with graded occupations

These three case reports are examples of the use of graded, purposeful activities in remediating the symptoms of vestibular disorders. Therapists can design individualized treatment plans for each patient by incorporating activities of interest to the patient. The treatment activities must include the particular head movements and positions that elicit vertigo during assessment. Additionally, activities must be interesting to the individual patient. Use of interesting activities may sustain the patient's interest and motivation for the treatment program and enable the patient to relate the learning process to real life experience. The principle that graded, repetitive head movement exercise is efficacious in reducing vertigo and disequilibrium in patients with vestibular disorders is now well accepted among physicians and therapists who treat these patients. The principle of adding meaning or purpose to otherwise rote exercise is well accepted among occupational therapists and is supported by evidence from the empirical literature (Heck, 1988; Kircher, 1984; Yoder, Nelson, & Smith, 1989). This concept of adding purpose to repetitive exercise may now be extended to the treatment of patients with peripheral vestibular disorders.

[Cervicogenic hearing loss]

Existing investigations of cervical hearing disorders have been carried out predominantly in patients in whom those with vertebrobasilar insufficiencies (VBI) could not be distinguished from patients suffering from functional deficit of the upper cervical spine. Since two different syndromes exist, no statement can be made about cervical hearing disorders. That deafness can occur in VBI is uncontested. In contrast, there remains a dispute whether a "vertebragenic hearing disorder" exists. This latter disorder is believed accompanied by tinnitus, a feeling of ear pressure, otalgia and deafness as symptoms of a functional deficit of the upper cervical spine. In reviewing the medical findings of 259 patients with well-defined functional deficits of the upper cervical spine and symptoms of cervical vertigo, subjective hearing disorders occurred in 15%. Audiometric threshold shifts of 5-25 dB, most often in lower frequencies, were observed in 40%. Additionally, results of click-evoked otoacoustic emissions (OAE) were negative in spite of approximately normal hearing. Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance.

Vestibular rehabilitation improves daily life function

This article reviews recent research that addresses the functional outcomes of intervention for vestibular disorders. Vestibular impairments cause disequilibrium, blurred vision, disorientation, and vertigo. These sensory disturbances and motor impairments in turn cause dysfunction in many activities of daily living and in social interactions that traditional medical treatments do not address. The motor sequelae of some vestibular disorders can be treated successfully with programs of graded exercises and activities, the functional implications of which are described herein. The functional impairments caused by other vestibular disorders, which cannot be treated with graded activities, are also described. These disorders include bilateral vestibular loss caused by connective tissue disorders or by the use of ototoxic medications, tumors of the labyrinth or vestibular nerve, and Meniere's disease. Occupational therapy intervention for these conditions may involve providing adaptive equipment, teaching alternative strategies for performing activities of daily living, and psychological intervention for depression and anxiety.

Recovery from unilateral vestibular nerve section in human subjects evaluated by physiological, psychological and questionnaire assessments

Patients undergoing vestibular nerve section for vertigo or acoustic neuroma surgery were compared pre- and post-operatively and during long-term follow-up using a range of tests including: nystagmography, impulsive rotational testing of the vestibulo-ocular reflex (VOR), ability to estimate and reproduce imposed rotational displacements, validated questionnaires rating vertigo, imbalance, autonomic reactivity and somatisation, and clinical and self-assessment scales of overall outcome in terms of symptoms and disability. Correlations were found between rating scale assessments, questionnaire scores and estimates of self-rotation. Neither nystagmography nor VOR tests correlated with the presence or severity of vertigo or imbalance. Post-operatively, vertigo patients reported that they had received significant relief, although they had higher incidences of residual complaints of imbalance and vertigo than patients after acoustic neuroma surgery. Factors impeding rehabilitation in patients with vertigo are discussed.

[Therapy of vestibular vertigo]

The non-surgical treatment of vestibular disorders must be based on current knowledge of vestibular pathophysiology. It is generally accepted that after vestibular lesions a self-repair mechanism exists that allows a more or less complete recovery. In cases of persisting vestibular complaints the physician's duty consists in stimulation of these pre-existing mechanisms. This can be done by physical exercises, as has been recommended since the work of Cawthorne and Cooksey in 1946. This concept is meanwhile supported by modern neurophysiological research. This article describes a short training program consisting of exercises for fixation during rotations, smooth pursuit, optokinetic nystagmus and motor learning mechanisms. Physical exercises can be reinforced by nootropic drugs.

Prolonged dysequilibrium in three cases with vestibular neuronitis: efficacy of vestibular rehabilitation

The clinical course of acute unilateral vestibular disturbance in 3 cases with vestibular neuronitis and a case with labyrinthine destruction was surveyed for a long-term period. Vestibular training with a modified Cawthorne-Cooksey's exercise was done in 2 of 3 cases with vestibular neuronitis and a case of labyrinthine destruction. All had no severe troubles in activities of their daily lives over one year after the onset of the disease, but the central compensation was not completed, even in a young patient, in a case of labyrinthine destruction and in a well trained case. Spontaneous nystagmus to the affected side and increase of body sway with eyes closed were revealed by examinations in all cases. Physical exercise was found to be effective for relief from vestibular ataxia, but it was difficult to keep the effect even after training.

[Conservative and functional treatment of the cervical spine]

Physiotherapy is the basic treatment for functional disorders of the cervical spine. The aspects of good physiotherapy are demonstrated and a plea is made that ENT surgeons should be trained in manual therapy.

[Surgical and physical therapy treatment of benign paroxysmal positional vertigo]

Two treatments for the benign paroxysmal positional vertigo are presented and evaluated in this article. The first type of treatment is the surgical section of the posterior ampullary nerve according to Gacek and the second is physiotherapeutic by the manoeuvre of Semont. The section of the posterior ampullary nerve has been realised between 1980 and 1986 on 5 patients suffering from persistent and disabling positional vertigo. All 5 patients were relieved from their vertigo immediately after the operation. One patient developed a post-operative hearing loss. The physiotherapeutic manoeuvre of Semont, which has been developed in order to liberate otolithic deposits from the cupula of the posterior semi-circular canal is applied in our clinic since 1985 as treatment of the benign paroxysmal positional vertigo. The efficiency of the manoeuvre was tested at first in a retrospective study on 50 patients. A single manoeuvre cured 20 of these patients and 15 others were cured after a second manoeuvre. Then, a controlled and prospective study was performed: the clinical course of 40 patients without treatment was compared with 37 patients treated with Semont's manoeuvre. In the group of patients without treatment, only 17 were spontaneously cured from their positional vertigo after 18 days of evolution. In the group treated by Semont's manoeuvre 19 patients were completely healed from vertigo and 16 others were greatly improved. On the basis of these favourable results the authors recommend to treat all cases of paroxysmal positional vertigo at first with Semont's manoeuvre. The section of the posterior ampullary nerve should be restricted to the rare cases with persistent and disabling vertigo.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rehabilitation of patients with vestibular disorders]

The connections between the two vestibular nuclei permit vestibular compensation after unilateral lesions. The interactions between the vestibular and the visual and proprioceptive system can support vestibular compensation. Our physical training program for the treatment of vertigo is based on these mechanisms. The training consists of fixation exercises, smooth pursuit and motor learning by proprioceptive cognition. The results are very convincing.