Treatment Options for Meniere's Disease

Vestibular Rehabilitation for Meniere's Disease

In a healthy vestibular system, visual input (information about the environment), somatosensory input (information about where the limbs are in space), and vestibular input (information about our body position in space) all work together to enable a person to maintain balance. When any of these systems do not work properly, the brain senses conflicting information which results in dizziness, vertigo, and/or problems with balance. One of the consequences of surgery to control vertigo is the loss of or reduced levels of vestibular function in the effected ear. Fortunately, many people are able to regain balance and reduce dizziness or vertigo through vestibular rehabilitation. The goal of vestibular rehabilitation is to promote central compensation by retraining the brain to recognize and coordinate signals from the vestibular system with signals from the visual and somatosensory systems, thereby restoring balance and reducing/eliminating vertigo and dizziness.

Vestibular rehabilitation is also beneficial for patients in whom severe vertigo attacks have abated in the natural course of Meniere's disease but who are left with residual problems with balance. The activities involved with vestibular rehabilitation foster adaptation to decreased functioning of the vestibular system and work on the enhancement of remaining function.

Vestibular rehabilitation consists of three aspects:

• Habituation - action that causes dizziness or vertigo is continually repeated so that the body and brain become accustomed to that activity and no longer react
• Balance retraining to reduce unsteadiness and restore balance
• Head-eye coordination reduce symptoms of vertigo related to the eyes gazing at a given point

The therapist begins by identifying positions and movements that induce vertigo and then creating exercises or tasks that focus on those movements. Some tasks are incorporated into daily activities and some are practiced on a formal basis a few times a day. Initially, the exercises may cause an increase of vertigo or imbalance as the brain tries to unlearn an existing pattern and learn a new response. With time, however, coordination improves and symptoms abate. The patient may also experience headaches, fatigue, nausea, or muscle tension, all of which eventually diminish or disappear. Rehabilitation can begin after the patient has recovered from surgery or while the patient is still in the hospital. Improvement is usually seen within 4-6 weeks.

In addition to the benefits for people who have undergone surgery for Meniere's, vestibular rehabilitation is also important for patients with Meniere's disease who do not necessarily undergo surgery but may adopt a sedentary way of life in the effort to avoid movements which may cause vertigo. The vestibular therapist also may help those patients develop an appropriate fitness program since good general health is also important.

Additional benefits of vestibular rehabilitation were revealed in a study completed in 2005 where a group of patients with Meniere's disease whose severe vertigo attacks were controlled with medication but who suffered from disequilibrium or unsteadiness between vertigo attacks underwent vestibular rehabilitation. None of these patients underwent surgery. All subjects reported significant improvement in balance function which was also demonstrated on objective tests. The authors noted that this is the first study done which demonstrates benefit of vestibular rehabilitation while receiving medical treatment only.

For more information about this study, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16143175&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum