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Yes, some vestibular disorders are by essence less responsive to vestibular rehabilitation than others. The principle of vestibular rehabilitation is to decrease symptoms by training the brain to optimize the use of the inner-ear input and to integrate that input effectively with the visual and proprioceptive information. Sudden changes in inner ear function can produce severe symptoms of vertigo and vomiting but once the inner ear function stabilizes, the brain can be trained to readjust to it.
However, if the nature of the vestibular disorder is to fluctuate or to deteriorate progressively, it can be extremely challenging for the brain to adjust to these repetitive changes. Individuals suffering from Ménière’s disease, for example, are not good candidates for vestibular rehabilitation when they are going through active stages of the disorder in which spells are happening often. Patients with recurrent types of vestibular disorders often benefit more from medical management of the attacks than from vestibular rehabilitation.
One vestibular disorder that does not classically fluctuate but also does not respond well to vestibular rehabilitation is superior canal dehiscence. In cases not treated surgically, avoidance of triggers remains the best management strategy; for example, patients should avoid exposure to loud sounds that can trigger dizziness or imbalance.
All of us experience the need to “pop” our ears when changes in elevation occur. However, people who suffer from Ménière’s disease are more markedly affected by the change in atmospheric pressure. While normal people feel instant relief opening the Eustachian Tube and equalizing pressure in the middle ear, people who suffer from Ménière’s Disease also get the inner ear affected by the pressure. This may cause increased tinnitus, dizziness and changes in hearing.
The ventilation tube aims at equalizing the middle ear pressure with the outside environment, but it will likely not change the inner ear effects of the atmospheric pressure changes. Studies done comparing symptoms between groups of people with and without ventilation tubes fail to show a significant improvement in the group with tubes.
In summary, ventilation tubes have been shown to be effective in middle ear disorders (such as fluid behind the eardrum), but may not alleviate inner ear symptoms associated with changes in atmospheric pressure. The tube may help equalize the pressure and you may feel less of an urge to “pop,” but you may continue to experience these symptoms due to the inner ear disorder. Make sure to discuss pros and cons of having ventilation tubes put in with your Ear, Nose and Throat doctor. Read more about Ménière’s disease.
My vestibular neuritis symptoms of imbalance and nausea get worse with weather changes. Is this due to atmospheric pressure changes?
The relationship between changes in barometric pressure and dizziness have been described in medical literature, particularly in patients suffering from migraine related vertigo and Ménière’s disease. Both of these vestibular disorders are characterized by an episodic nature. This means that the symptoms come and go, in spells.
For some people, these episodes can be triggered by changes in atmospheric pressure, such as weather changes before a storm or travelling from sea level to higher altitude. Read our recent post on Facebook about this topic.
You mention the recurrent nature of your dizziness – vestibular neuritis is not classically recurrent like you describe. It is usually caused by a single viral or bacterial attack on the vestibular nerve. Symptoms typically start quite suddenly and may include severe vertigo and vomiting lasting for several hours. This is due to a loss in function of the vestibular nerve that can be temporary or permanent. During the recovery stage, which can last for several weeks, symptoms gradually improve and plateau.
We recommend speaking to your family doctor and/or your ENT doctor about the episodic/recurrent nature of your dizziness and vasovagal spells. Further investigation may be warranted into their cause.
Complex vestibular disorders are challenging to treat. For example, it can be very difficult to tease out the symptoms that distinguish Ménière’s disease or migrainous vertigo; they have very similar symptoms, but are treated very differently.
More complex cases are very individual and cannot always be pigeon-holed as Ménière’s or migrainous vertigo or some other particular disorder. Patients may have some but not all of the characteristics of Ménière’s disease, for example, and that is frustrating for doctors.
About a third of patients benefit from medications such as betahistine. Others benefit from a reduced salt diet and other dietary changes. When spells happen often and quality of life is reduced, intratympanic (within the middle ear) steroid injections may be used by the ear specialist (otologist). The objective of the injections is to prevent or reduce further attacks as each attack results in a further loss of hearing and balance. Read more about Ménière’s disease.
Vestibular rehabilitation usually doesn’t help in the early stages of Ménière’s disease. Patients will have attacks that can neither be predicted nor be kept under control with exercises. Vestibular rehabilitation doesn’t work well when a patient’s condition fluctuates – that is, good hearing and balance between attacks and poor during attacks.
With continued attacks, patients lose much of their hearing and balance. Once the balance function is greatly diminished and doesn’t change a lot when in or between attacks, the patient is a candidate for vestibular rehabilitation. If a patient has lost balance function on one side, the brain can be trained to compensate for the loss; however, it takes practice.