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Susan J. Herdman, PT, PhD; Michael C. Schubert, PT, PhD; Vallabh E. Das, PhD; Ronald J. Tusa, MD, PhD

Arch Otolaryngol Head Neck Surg. 2003;129:819-824.

Objective  To determine the effect of vestibular exercises on the recovery of visual acuity during head movement in patients with unilateral vestibular hypofunction.

Study Design  Prospective, randomized, double-blind study.

Setting  Ambulatory referral center.

Patients  Twenty-one patients with unilateral vestibular hypofunction, aged 20 to 86 years.

Intervention  One group (13 patients) performed vestibular exercises designed to enhance the vestibulo-ocular reflex, and the other group (8 patients) performed placebo exercises. The placebo group was switched to vestibular exercises after 4 weeks.

Outcome Measures  Measurements of dynamic visual acuity (DVA) during predictable (DVA-predictable) and unpredictable (DVA-unpredictable) head movements by means of a computerized test and measurement of intensity of oscillopsia by means of a visual analog scale.

Results  As a group, patients who performed vestibular exercises showed a significant improvement in DVA-predictable (P<.001) and DVA-unpredictable (P<.001), while those performing placebo exercises did not (P = .07). On the basis of stepwise regression analysis, the leading factor contributing to improvement was vestibular exercises. This reached significance for DVA-predictable (P = .009) but not DVA-unpredictable (P = .11). Other factors examined included age, time from onset, initial DVA, oscillopsia, and duration of treatment. Changes in oscillopsia did not correlate with DVA-predictable or DVA-unpredictable.

Conclusions  Use of vestibular exercises is the main factor involved in recovery of DVA-predictable and DVA-unpredictable in patients with unilateral vestibular hypofunction. Exercises may foster the use of centrally programmed eye movements that could substitute for the vestibulo-ocular reflex. The DVA-predictable would benefit more from this than would DVA-unpredictable.

From the Departments of Rehabilitation Medicine (Drs Herdman and Schubert), Otolaryngology (Drs Herdman and Tusa), and Neurology (Drs Das and Tusa), Emory University, Atlanta, Ga. Dr Schubert is now with the Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md. The authors have no relevant financial interest in this article.

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