Recovery after early vestibular rehabilitation in patients with acute unilateral vestibular loss

• The aims of this study were to follow the recovery process, and explore the disease impact on sick leave in patients with acute unilateral vestibular loss (AUVL). Another aim was to investigate whether initial signs of nystagmus, caloric response, and subjective symptoms of vertigo could predict the return to work. Recovery was followed through the reduction in spontaneous and head-shaking nystagmus, evaluated by Video-Frenzel examination, and by caloric response/asymmetry and spontaneous nystagmus, evaluated by bithermal binaural caloric testing. Information regarding employment, sick leave and subjective symptoms of vertigo was collected using a questionnaire. Twenty-seven patients with AUVL participated in a physiotherapy training programme, starting within 48 h of disease onset. Four assessments were performed: at disease onset, in the acute stage, and after one and six months. In most patients a very rapid cessation of spontaneous nystagmus could be observed (14/27 at a median time of two days after disease onset, a further 10 patients after one month and the remaining three patients after six months). A more prolonged persistence of head shaking nystagmus was observed (24/27, 14/27 and 5/21 of the patients showed head-shaking nystagmus at the three assessments). Caloric asymmetry was normalized after six months in 11/27 patients. A positive and significant correlation was observed between long-lasting sick leave and caloric asymmetry, sense of unsteadiness when standing and walking and older age. Unsteadiness when standing and walking, as well as existence of spontaneous nystagmus, were also positively and significantly correlated with the degree of caloric asymmetry. Spontaneous or head-shaking nystagmus, caloric asymmetry and subjective vertigo at disease onset did not, however, predict sick leave after one or six months. Recovery was excellent in most of the patients.

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