How can we improve outcomes for patients with acute vestibular neuritis?
Reviewed by Aileen Lambert

Vestibular neuritis is a common disorder that can leave up to 50% of patients with persistent vertigo symptoms for months to years following the acute insult. Often their first contact with ENT or balance specialists is many months after the initial presentation. This well-designed RCT from a group in Norway seeks evidence for the role of early intervention with vestibular physiotherapy on both short and long-term outcomes. The 65 trial patients were enrolled from those presenting acutely to ENT up to seven days after acute vertigo onset, with confirmation of vestibular hypofunction/failure with caloric tests. The control group had ‘standard care’, which involved oral prednisolone for 10 days and general advice. The intervention group had standard care plus a twice-weekly, small-group, physiotherapist-led vestibular rehabilitation programme for 10 weeks, which continued for up to 12 months with reducing frequency, depending on patient recovery. The programme involved habituation, gaze stabilisation, balance, and gait exercises. This was in addition to daily home exercises. The outcomes measured in this trial include perceived dizziness during head motion (based on Yardley’s six subscale provocation movements), as well as walking speed, standing balance, and a range of subjective dizziness scales. Twenty-seven patients were randomised to the physiotherapy intervention group, and this group had a statistically significant improvement in overall perceived dizziness and in self-reported scales at three and 12 months, compared with those in the standard care arm. This study has a longer intervention period and longer follow-up data than others exploring this type of intervention for acute vestibular failure. The results of this trial highlight that we need to consider how we can design our services to actively provide early intervention to patients who present with vestibular neuritis.

Efficacy of Vestibular Rehabilitation Following Acute Vestibular Neuritis. A randomised controlled trial.
Tokle G, Mørkved S, Bråthen G, et al.
OTOLOGY AND NEUROTOLOGY
2020;41(1):78-85.