Vestibular Rehabilitation: An Effective Treatment for Dizziness, Vertigo, and Balance Problems

Do you suffer from dizziness, lightheadedness, or unsteadiness? If so, you are not alone. It has been estimated that 65% of individuals over the age of 60 experience dizziness or loss of balance on a regular basis and vestibular problems account for one-third of all patients with vertigo and dizziness.1, 2 Recent research by Johns Hopkins University suggests that as many as 35% of adults over the age of 40 in the United States (69 million Americans) have experienced some form of a vestibular dysfunction.3

What is the vestibular system?

The vestibular system lies deep within the ear and includes the utricle, saccule, and three semicircular canals. The utricle and saccule detect vertical and linear head movement and the semicircular canals detect rotational head movement. Both left and right vestibular systems constantly send information to the brain about your head position. The brain integrates this information with the input it receives from your eyes, muscles, and joints to assist in coordinating head, eye, and body movements to maintain equilibrium. When the vestibular system is not working properly due to illness or injury the input to the brain is altered and symptoms may develop including dizziness, vertigo, imbalance, nausea, and disequilibrium.

Vestibular System


What are common vestibular pathologies?


Common disorders of the inner ear include benign paroxysmal positional vertigo (BPPV), vestibular neuritis and labyrinthitisacoustic neuroma, bilateral loss of inner ear function due to ototoxicity or autoimmune disease, and Meniere’s disease. Other conditions that may cause dizziness and/or imbalance that would benefit from vestibular rehabilitation include cervicogenic dizziness, and brain damage from head trauma, tumors, and stroke.

What is Vestibular Rehabilitation?

Vestibular rehabilitation is a specialized type of physical therapy in which specific exercises are used to promote brain/central nervous system compensation for inner ear deficits. Your physical therapist will perform a thorough assessment and develop an individualized treatment program aimed at decreasing your symptoms and improving your function.

A treatment program may include:

  • Balance/coordination activities to retrain body awareness
  • Gaze stability exercises to decrease dizziness
  • Flexibility and/or strengthening exercises
  • Particle repositioning maneuvers to treat BPPV

Does Vestibular Rehabilitation work?

Research suggests that vestibular rehabilitation therapy is very effective in reducing symptoms of many types of vestibular disorders.4  Additionally, multiple randomized controlled trials provide strong evidence that the Canalith Repositioning Maneuver (Epley Maneuver) is very successful in treating BPPV in as little as one to two sessions.5, 6, 7

What is the next step?

Many other serious health conditions can cause dizziness including cardiovascular, neurological and metabolic problems. If you experience dizziness discuss your symptoms with your health care provider to determine if you are a good candidate for vestibular rehabilitation.

Please email me if you have questions about all of this.


Hobeika CP. Equilibrium and Balance in the Elderly. Ear Nose Throat J. August 1999; 78(8): 558-62, 565-6.

Neuhauser HK, Radtke A, von Brevern M et al. Burden of Dizziness and Vertigo in the Community. Arch Intern Med. 2008;168(19):2118–2124.

3Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of Balance and Vestibular Function in US Adults. Arch Intern Med. 2009: 169(10): 938 944.

Hillier SL, Hollohan V. Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction. Cochrane Database of Systematic Reviews 2007. Issue 4. CD005397.Pub. 2; 2007.

Helminksi J, Janssen I, Hain T, Zee DS. Effectiveness of Particle Repositioning Maneuvers in the Treatment of Benign Paroxysmal Positional Vertigo: A Systematic Review. PHYS THER. 2010; 90:663-678.

Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS. Practice Parameter: Therapies for Benign Paroxysmal Positional Vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008;70:2067–2074.

Hilton M, Pinder D. The Epley (Canalith Pepositioning) Maneuver for Benign Paroxysmal Positional Vertigo. Cochrane Database of Systematic Reviews 2004. Issue 2.