PURPOSE: Vestibular schwannoma removal causes unilateral vestibular deafferentation, which results in dizziness and postural unsteadiness. Vertigo and balance problems together are among the most important aspects affecting quality of life. Intensive vestibular rehabilitation, which starts before surgery, with following postsurgical supervised rehabilitation, using visual biofeedback propose an instrument to accelerate a recovery process. Another option how to accelerate the vestibular compensation, is employment of presurgical gentamicin ablation together with vestibular rehabilitation (prehabilitation) of vestibular function. Purpose of present study was to examine the dynamics of vestibular compensation process using supervised intensive vestibular rehabilitation with visual biofeedback in the short-term postsurgical period. The second aim was to compare both studied groups mainly to evaluate if prehabilitation has potential to accelerate the compensation process in the early postoperative course. METHODS: The study included 52 patients who underwent the retrosigmoid vestibular schwannoma removal. They were divided into two groups. The first group was prehabilitated with intratympanic application of gentamicin before surgery to cause unilateral vestibular loss (14 patients), the second group (38 patients) was treated in standard protocol without prehabilitation. All patients underwent at home vestibular training before surgery to learn new movement patterns. Following the surgery supervised intensive vestibular rehabilitation including visual biofeedback was employed daily in both groups between the 5th and 14th postoperative day. Outcome measurements included an evaluation of subjective visual vertical (SVV), posturography and the Activities-Specific Balance Confidence Scale (ABC). ANOVA for repeated measurements was used for statistical analysis. RESULTS: We observed significant improvement in SVV (p < 0.05), posturography parameters (p < 0.05) and ABC scores (p < 0.05) with postoperative rehabilitation program following surgery in both groups. There was no statistically significant difference between group treated by prehabilitation and group without prehabilitation. CONCLUSIONS: Results of this study showed that intensive postsurgical rehabilitation represents key factor in compensation process following retrosigmoid vestibular schwannoma surgery. Prehabilitation did not speed up recovery process.

Department of Otorhinolaryngology 3rd Faculty of Medicine University Hospital Kralovské Vinohrady Charles University Prague Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University and University Hospital Motol Postgraduate Medical School Prague Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Zobrazit více v PubMed

Rev Laryngol Otol Rhinol (Bord). 2003;124(1):45-52 PubMed

J Vestib Res. 2018;27(5-6):313-325 PubMed

Laryngoscope. 1995 Jul;105(7 Pt 1):686-92 PubMed

Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1355-60 PubMed

Otol Neurotol. 2005 Mar;26(2):265-9 PubMed

IEEE Trans Biomed Eng. 1996 Sep;43(9):956-66 PubMed

Acta Otolaryngol. 2002 Dec;122(8):841-50 PubMed

Ann N Y Acad Sci. 2009 May;1164:257-62 PubMed

Biomed Res Int. 2014;2014:315952 PubMed

Cas Lek Cesk. 2010;149(6):269-76 PubMed

Front Neurol. 2015 Jan 06;5:285 PubMed

Otolaryngol Head Neck Surg. 1995 Jul;113(1):77-87 PubMed

Acta Otolaryngol. 2007 Dec;127(12):1236-40 PubMed

Eur Arch Otorhinolaryngol. 2006 May;263(5):414-20 PubMed

Neurosci Res. 2006 Jun;55(2):171-81 PubMed

Neurology. 2009 May 12;72(19):1689-92 PubMed

Biomed Res Int. 2016;2016:6767216 PubMed

Physiother Res Int. 2005;10(1):10-22 PubMed

Ann Otol Rhinol Laryngol. 1988 Jan-Feb;97(1):55-66 PubMed

Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Sep;132(4):197-203 PubMed