RT Book, Section
A1 Curthoys, Ian S.
A1 Halmagyi, G. Michael
A2 Herdman, Susan J.
A2 Clendaniel, Richard A.
SR Print(0)
ID 1135015190
T1 Vestibular Compensation—Recovery after Unilateral Vestibular Loss
T2 Vestibular Rehabilitation
YR 2014
FD 2014
PB F. A. Davis Company
PP New York, NY
SN 9780803639706
LK fadavispt.mhmedical.com/content.aspx?aid=1135015190
RD 2023/03/20
AB Sudden,  complete  unilateral  loss  of  vestibular  function  in  normal,  healthy  individuals  results  in  a  dramatic  series  of  symptoms—strong  sensations  of  turning  (vertigo),  nausea,  rapid  eye  movements  (nystagmus),  oscillopsia  (the  illusion  that  the  visual  world  is  moving  as  they  move  their  head),  falling  to  the  affected  side,  gait  ataxia,  postural  instability,  distortions  in  the  perception  of  body  orientation  and  movement,  and  inadequate  compensatory  responses  to  head  movement.  We  will  use  the  term  unilateral  vestibular  deafferentation  (UVD)  syndrome  to  refer  to  these  symptoms.  Such  patients  are  greatly  distressed.  Over  the  first  few  days  most  of  the  symptoms  decline  and  the  patient's  distress  correspondingly  diminishes.  For  most  patients,  these  symptoms  have  disappeared  within  a  few  weeks,  and  the  patients  return  to  their  normal  lifestyle  and  are  happy  with  their  recovery.  The  term  used  to  describe  that  general  recovery  is  vestibular  compensation,  and  superficially  it  seems  that  there  is  a  full  recovery  and  vestibular  function  has  returned.  Indeed,  in  a  few  patients  this  is  exactly  what  does  happen:  some  patients  with  vestibular  neuritis  experience  all  these  symptoms,  but  as  their  vestibular  neuritis  diminishes,  their  peripheral  vestibular  function,  as  shown  by  new  specific,  objective  tests,  is  completely  restored.  However,  in  most  patients  there  is  little  or  no  restoration  of  vestibular  function,  and  when  their  peripheral  vestibular  function  is  tested  by  these  new  tests  of  canal  and  otolith  function,  the  permanent  loss  is  clearly  shown.  Nevertheless,  most  patients  with  permanent  UVD  recover  and  are  happy—they  are  “well-compensated.”  They  do  not  experience  vertigo,  nausea,  oscillopsia,  or  postural  unsteadiness  (see  Box  8-1).