Meniere’s disease and vestibular rehabilitation

Meniere’s Disease and Vestibular Rehabilitation

It is a chronic disease that causes dizziness, ringing in the ears, tinnitus, a feeling of fullness in the ear, nausea, vomiting and heavy hearing, which occurs as a result of hydrops in the inner ear fluids.
Our aim from Vestibular Rehabilitation;
Accelerating the central compensation process (thus vertigo and postural disorders)
– feeling safe,
– have no problems participating in daily active life,
– preventing falls and injuries, and
– isolating from society
* anxiety,
* panic disorder and
* It is aimed to get away from additional psychological disorders such as major depression.
Before the patients are included in the rehabilitation program, they should be informed and the patient should be
Make sure you understand the situation. This is important, this program is prepared as a program specific to the patient, it is not a miraculous treatment program, if he actively participates in the treatment, it will provide maximum benefit.
should be explained to the patient and fully understood by the patient.
The team should consist of an ENT specialist trained in vestibular diseases and autoneurology, an audiologist, a good audiovestibular laboratory and a physiotherapist experienced in vestibular rehabilitation (VR).
Treatment should be started as soon as possible because when visual and motor experience is delayed, there is a delay in recovery. The duration of treatment is usually in the form of programs of 4-8 weeks.
a. Unilateral / bilateral peripheral lesions,
b. central lesions,
c. Cervical vertigo,

D. Multisensory diseases (visual, proprioceptive) aging,
to. Anxiety and panic disorders
Patients with vestibular problems with a fluctuant course (eg Meniere’s Hospital) have a low cure rate
However, with a good choice, they can be taken into the VR program. The first attack is defined by the patient as a crisis. If the symptoms are described as milder in subsequent attacks, it can be thought that the problem is due to insufficient compensation and the chance of VR success increases, however; Progressive or fluctuant vestibular pathology is more likely if symptoms increase over time or if subsequent attacks are similar or more severe than the first attack. These patients have an ongoing labyrinth pathology and VR has little or no chance of success.
is low. Sometimes Meniere’s patients complain of positional vertigo or chronic vestibular problems between attacks. Here, the time between attacks becomes important. Attacks that occur once a month on average make us think that the disease progresses rapidly and that VR has a low chance of success in this chronic background.
Medical or surgical treatment methods are more suitable for the control of symptoms.
Balance disorder of patients before and after VR;
-physical and
– Evaluating in terms of functional parameters, Imbalance Inventory is created.
This assessment is based on 25 questions and the highest level of imbalance is 100 points.
is scored. Generally, VR is executed in two ways:
-The first is preparing a program for the person, then teaching this program to the patient and the patient applying this prepared program at home. The physiotherapist either visits the patient at home at regular intervals or gets information about the patient and directs them by phone.
The second method, which is more preferred; Also tailored to the patient
It is the implementation of the rehabilitation program in rehabilitation centers or at home for 4-8 weeks with a specialist physiotherapist on certain days of the week. The second method shows higher patient compliance and higher success rate than the first method. In this way, an 85% reduction in symptoms was detected after treatment in patients who were included in the rehabilitation program. In the meantime, patients should be carefully questioned while being included in the rehabilitation program, and the use of drugs that may delay compensation should be discontinued.

A general exercise program for traumatic or other causes of imbalance
– head movements,
– with eye movements
– coordination of head movements,
– total body movements and
– aimed at providing balance.
All exercises are performed lying on your back, sitting, standing and in motion. In addition, walking programs should be added to the exercise prescription. As a result of repetitive encounters with the position that creates the stimulus, patients begin to tolerate the same position without encountering any problems. If significant nausea and vomiting occurs during the movements, it is interrupted until the next session. Typical movements that cause symptoms in the patient are determined, and special exercises containing these movements are planned to be performed twice a day. The VR programs used today are composed of various modifications of the Cawthorne-Cooksey movements.

Cawthorne-Cooksey Movements:

A. Lying on your back:
1. Eye movements (first slow, then fast)
a. Right-Left
b. Up down
c.The physiotherapist stands in front of the patient and the patient focuses on the finger approaching from 90 cm to 30 cm.
2. Head movements (Eyes focus on a point 30 cm away)
a. Right-Left rotation
b. Up-Down flexion and extension
3. Making head movements with eyes closed

B. In a sitting position:
1. Head-eye movements in the same way
2. Shoulder elevation, depression and rotation
3. Do not lean forward

In a standing position:
1. The exercises in A1, A2 and B3 are repeated.
2. Standing up from a sitting position with eyes open and closed
3. The physiotherapist and patient stand face to face and a small ball is thrown from hand to hand at eye level.
4. The ball rolls under the knees.
5. Stand up from sitting position and rotate.

Standing motion:
1. The patient turns around the physiotherapist in the middle and throws a large ball towards the physiotherapist.
2. Walk from wall to wall in the room with eyes open and closed.
3. Walk uphill and downhill on the ramp with eyes open and closed.
4. Eyes open and closed, going up and down the stairs.
5. A type of game (eg basketball) that includes sudden stopping and bending movements may be suggested.

Another branch of vestibular rehabilitation is the Visual Feedback method. It has been developed based on the fact that the vestibular adaptation mechanism can be accelerated visually as well as movement and coordination exercises. It works with the principle of giving visual stimuli on a moving platform.

The group of patients who benefit most from VR is the group with unilateral permanent loss of labyrinth function.
The group with unilateral labyrinth damage, the group with bilateral labyrinth damage, and the patient group with sensory disorders (visual, proprioceptive) with vestibular system disorder (lowest success rate), increasing gradually over time, respectively, with decreasing rates.

Prof. dr. Selcuk Onart