Vestibular rehabilitation (VR) for patients with bilateral vestibular dysfunction is considered, in general, to be less effective as compared with that for those with unilateral vestibular dysfunction. Herein, we report the case of a patient with bilateral vestibular dysfunction in whom VR was associated with marked improvement of the vestibular symptoms.
The patient was a 67-year-old man who primarily communicated through writing because of severe bilateral sensorineural hearing loss and speech impairment since childhood. He presented with a 2-year history of dizziness and increasing unsteadiness, particularly during movements and in dark environments. Vestibular function testing led to the diagnosis of bilateral vestibular dysfunction, and VR was prescribed.
Over a three-month period, the patient underwent seven 40-minute VR sessions with a physical therapist and performed exercises at home for at least 20 minutes daily. The VR program included gaze stability exercises, habituation exercises, and substitution exercises. Since verbal communication was not possible, alternative communication strategies, such as instructions displayed on a tablet screen and gestures, were employed during the VR sessions. The patient successfully completed the three-month VR program without any adverse events.
The dizziness severity, as assessed by the Dizziness Handicap Inventory (DHI), improved, with the score decreasing from 24 to 12. Motion sensitivity, measured by the Motion Sensitivity Quotient (MSQ), improved, with a reduction of the score from 28.3 to 4.7. Gait function, evaluated by the Functional Gait Assessment (FGA), improved, with the score increasing from 22 to 27. Static balance, measured by total path length in the eyes-closed without rubber condition of posturography, improved, with decrease of the path length from 472 cm to 267 cm in 60 seconds. The patient continues to visit our otolaryngology department and is now able to carry out daily activities without difficulty.
Despite the patient being unable to communicate verbally, the implementation of alternative communication methods allowed effective VR to be implemented, leading to symptom improvement.
