Long-term course and relapses of vestibular and balance disorders

Abstract

The long-term course and the frequency of relapses for various peripheral vestibular disorders and somatoform phobic postural vertigo are discussed with respect to the clinically most important questions for thus afflicted patients. This review is mainly based on our own long-term follow-up studies and takes into consideration the most relevant literature. The following syndromes are discussed in detail. Vestibular neuritis: the recovery rate of peripheral vestibular function lies between 40-63% depending on early-onset treatment with corticosteroids; the recurrence rate within 10 years is 2%. Menière's disease: loss of auditory and vestibular function occurs mainly in the first 5 to 10 years; frequency of vertigo attacks may decline after 5 to 10 years; bilateral involvement increases with increasing duration of the condition in up to 30-50%; vestibular drop attacks may occur early or late within the course, mostly with spontaneous remission; high-dose and long-term treatment with betahistine significantly reduces attack frequency in Menière's disease, Benign paroxysmal positioning vertigo: the recurrence rate is 50% within 10 years (in females 58%, in males 39%), most recurrences (80%) being observed within the first year after initial relief; recurrence rate in the seventh decade is half of that in the sixth decade. Vestibular paroxysmia: medical treatment with carbamazepine or oxcarbazepine leads to a continuous significant reduction in attack frequency, intensity, and duration of 10-15% of baseline. Bilateral vestibulopathy: recovery of vestibular function is limited to single cases depending on their etiology. Phobic postural vertigo: within 5 to 16 years 27% of the patients are symptom-free, 48% improve, 22% remain unchanged, and 3% worsen; a detailed explanation of the mechanisms that cause and the factors that provoke attacks is imperative, as well as instructions for self-controlled desensitization within the context of behavioral therapy.

Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

“…Static signs and symptoms gradually abate within weeks, even in the presence of continued peripheral dysfunction. However, if vestibular function does not recover, dynamic signs will persist for life, leading to blurred vision and imbalance when patients turn their head toward the side of the affected labyrinth 14. Most patients will be able to walk within 48 hours, and most can return to normal activities within about 2 weeks.…”

“…The recurrence rate of vestibular neuritis is low, and no recurrences are observed in the initially affected ear. However, a relapse may go undetected in those with a persistent and complete unilateral vestibular deficit 14. The symptoms may either worsen or be relieved during vestibular adaptation exercises; this seems to be a common pattern during improvement and is related to overactivity during the good days, which causes excessive fatigue resulting in increased symptoms within 24-36 hours 1.…”

“…To achieve the final goal of vestibular recovery, the exercise is integrated into normal activities such as walking,43 rather than being performed with the patient sitting or standing quietly 58. Various games can be introduced to reduce the monotony of purely remedial exercises 14. Patients who are gradually and safely exposed to a wide variety of sensory and motor environments are teaching their nervous systems to identify strategies to accomplish functional goals 40…”

Perspectives in vestibular diagnostics and therapy

“…While the SCC are largely affected in vestibular neuritis [10], in canal paresis [4], [11], the otolith organs have been described to be affected separately for the first time just recently [3]. These disorders can be accompanying in Meniere’s disease (MM), in case of canalolithiasis, in vestibular neuritis, in posttraumatic disorders after blunt head trauma or microsurgery of the ear (e.g., cochlear implantation, CI) [12], [13], [14], [15].…”

“…Uncompensated vestibular disorders (e.g., after vestibular neritis or removal of an acoustic neuroma) [4], patients with multiple lesions or after stroke have undergone so-called vestibular exercises for decades [11], [84], which is done alone or under supervision [85]. The main targets of those approaches are to improve central compensation and to activate the vestibulo-spinal and opto-vestibular pathways [86].…”