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Is a Cholesteatoma Life-Threatening?

 A cholesteatoma can be dangerous to your health if left untreated. This abnormal skin growth behind the eardrum can lead to serious complications by damaging crucial structures in the ear. Here’s what you need to know:   Potential Complications:   Facial Nerve Damage: This can lead to facial palsy. Hearing Bones Damage: This may cause deafness and tinnitus. Balance System Damage: This can result in dizziness or total loss of balance and hearing in that ear (known as a dead ear). Brain Risks: The bony barrier between the ear and brain can wear away, increasing the risk of severe infections. Infection Risks: Mastoiditis: Infection spreading into the mastoid bone. Brain Abscess or Meningitis: Infections spreading into the brain. Blood Vessel Blockage: Infection in the mastoid bone can block the main blood vessel, draining blood from the brain. Treatment:   Surgical Removal: Nearly always recommended to prevent these dangerous complications. If you suspect you

"When your world is spinning, vestibular rehabilitation becomes your compass, guiding you back to a steady path and restoring your sense of direction."

 What is vestibular rehabilitation?


Vestibular rehabilitation is a specialized form of therapy that focuses on the treatment of disorders related to the vestibular system. The vestibular system is responsible for maintaining balance and spatial orientation in the body. When this system is disrupted, it can result in symptoms such as dizziness, vertigo (a spinning sensation), imbalance, and unsteadiness.


Vestibular rehabilitation aims to alleviate these symptoms and improve overall balance and stability through a series of exercises and therapeutic techniques. The therapy is typically performed by physical therapists or occupational therapists who have specialized training in vestibular rehabilitation.


During vestibular rehabilitation, the therapist evaluates the patient's condition and develops an individualized treatment plan based on their specific needs. The therapy may include exercises to improve gaze stability, balance training, habituation exercises to reduce sensitivity to motion, and coordination and strengthening exercises.


The exercises and techniques used in vestibular rehabilitation are designed to promote adaptation and compensation within the vestibular system. The goal is to help the brain adjust to the changes in the vestibular signals and enhance the body's ability to maintain balance and minimize symptoms.


Vestibular rehabilitation can be beneficial for various vestibular disorders, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, Ménière's disease, and post-concussion syndrome. It can also be helpful for individuals who experience balance problems due to aging or other causes.


It's important to consult with a healthcare professional, such as a physical therapist or an otolaryngologist, to receive an accurate diagnosis and determine if vestibular rehabilitation is appropriate for your specific condition.

Who needs to have vestibular rehabilitation treatment?


Vestibular rehabilitation treatment may be recommended for individuals who are experiencing symptoms related to a vestibular disorder or balance dysfunction. Some conditions that may benefit from vestibular rehabilitation include:


Benign Paroxysmal Positional Vertigo (BPPV): BPPV is a common vestibular disorder characterized by brief episodes of vertigo triggered by specific head movements. Vestibular rehabilitation can help in repositioning the displaced particles within the inner ear to alleviate symptoms.


Vestibular Neuritis: This condition involves inflammation of the vestibular nerve, often resulting in severe vertigo and dizziness. Vestibular rehabilitation can assist in compensation for the damaged vestibular system and improve balance.


Labyrinthitis: Labyrinthitis is an infection or inflammation of the inner ear, leading to symptoms such as dizziness, vertigo, and hearing loss. Vestibular rehabilitation may aid in the recovery of balance and reduce symptoms.


Ménière's Disease: Ménière's disease is a chronic condition characterized by recurring episodes of vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the affected ear. Vestibular rehabilitation can help manage symptoms, improve balance, and reduce the impact of vertigo attacks.


Post-Concussion Syndrome: Following a concussion, some individuals experience persistent dizziness, imbalance, and visual disturbances. Vestibular rehabilitation can be beneficial in addressing these symptoms and facilitating recovery.


Age-Related Balance Issues: As individuals age, they may develop balance problems due to age-related changes in the vestibular system and other factors. Vestibular rehabilitation can improve balance, reduce the risk of falls, and enhance overall stability in older adults.


It's important to note that the decision to undergo vestibular rehabilitation treatment should be made in consultation with a healthcare professional, such as a physical therapist or an otolaryngologist. They will evaluate your specific symptoms, conduct a thorough assessment, and determine if vestibular rehabilitation is suitable for your condition.

How does vestibular rehabilitation therapy work?

Vestibular rehabilitation therapy targets the underlying issues in the vestibular system and promotes compensation and adaptation to improve balance and reduce symptoms. Here's an overview of how vestibular rehabilitation therapy typically works:


Evaluation and Assessment: The therapy process begins with a comprehensive evaluation by a healthcare professional specializing in vestibular rehabilitation, such as a physical therapist or an otolaryngologist. They will assess your symptoms, medical history, and perform various tests to determine the nature and severity of your vestibular dysfunction.


Individualized Treatment Plan: A personalized treatment plan is developed to address your specific needs based on the evaluation results. The plan considers your symptoms, functional limitations, and goals for rehabilitation.


Canalith Repositioning Manoeuvres: If you have been diagnosed with BPPV, a common treatment technique involves canalith repositioning manoeuvres. These manoeuvres aim to reposition displaced calcium crystals (otoconia) in the inner ear that are causing vertigo. The most well-known manoeuvre is the Epley manoeuvre, but there are others that may be used depending on the location of the displaced crystals.


Vestibular Exercises: Vestibular rehabilitation therapy involves various exercises and activities that are designed to improve balance, coordination, and gaze stability. These exercises may include:


Gaze Stabilization Exercises: These exercises focus on maintaining a steady gaze while performing head movements, which helps to improve visual stability and reduce dizziness.


Balance Training: Balance exercises are performed to enhance stability and reduce the risk of falls. These exercises may include standing on unstable surfaces, performing specific movements while maintaining balance, and weight shifting exercises.


Habituation Exercises: Habituation exercises involve exposing the individual to control movements or situations that provoke dizziness or vertigo. Through repeated exposure, the brain gradually adapts and becomes less sensitive to these triggers, reducing symptoms over time.


Coordination and Strengthening Exercises: These exercises aim to improve overall coordination, strength, and flexibility, which are essential for maintaining balance and stability.


Home Exercise Program: In addition to in-clinic sessions, you will likely be prescribed a home exercise program to continue your rehabilitation between therapy sessions. Consistency and adherence to the exercises are crucial for achieving optimal results.


Progress Evaluation: Throughout the course of therapy, your progress will be regularly monitored and assessed. Adjustments to the treatment plan may be made based on your response to the therapy and changes in your symptoms.


Vestibular rehabilitation therapy is typically conducted over a period of several weeks to months, depending on the individual's condition and progress. Your healthcare provider will determine the specific duration and frequency of therapy sessions.


It's important to remember that vestibular rehabilitation therapy should be supervised and guided by a healthcare professional experienced in this area. They can provide proper instruction, monitor your progress, and make any necessary modifications to optimize your rehabilitation journey.

How long is a typical vestibular rehabilitation program?


The duration of a typical vestibular rehabilitation program can vary depending on several factors, including the individual's condition, the severity of symptoms, response to treatment, and personal progress. Vestibular rehabilitation programs can generally range from a few weeks to several months. Here are some considerations regarding the duration of a vestibular rehabilitation program:


Individualised Treatment: Each person's vestibular dysfunction and rehabilitation needs are unique. The treatment plan should be tailored to the individual's specific condition and goals. Some individuals may experience significant improvement and symptom relief within a shorter timeframe, while others may require a more extended period for optimal results.


Severity and Complexity of the Condition: The severity and complexity of the vestibular disorder or balance dysfunction can influence the duration of the rehabilitation program. Conditions such as uncomplicated BPPV may be resolved within a few weeks with targeted canalith repositioning maneuvers. On the other hand, conditions like chronic vestibular migraine or complex vestibular disorders may require a more extended and comprehensive rehabilitation program.


Compliance and Adherence: The effectiveness of vestibular rehabilitation depends on the individual's commitment to the treatment plan. Consistency and adherence to the prescribed exercises, both during therapy sessions and at home, play a crucial role in achieving desired outcomes. Active participation and regular practice of the recommended exercises can expedite progress.


Progress Evaluation and Adjustments: Throughout the rehabilitation program, periodic progress evaluations are conducted to assess improvements, symptom reduction, and functional gains. Based on these evaluations, the healthcare professional may make adjustments to the treatment plan, exercise regimen, or treatment techniques to optimize results. This ongoing assessment and modification process can impact the duration of the program.


It's important to note that vestibular rehabilitation is individualized, and the duration can vary significantly. The healthcare professional specializing in vestibular rehabilitation, such as a physical therapist or an otolaryngologist, will assess your specific needs, monitor your progress, and provide guidance on the expected duration of your program.


Regular communication with your healthcare provider is essential to address any concerns, track progress, and ensure the treatment plan is appropriately adjusted.


What are the advantages of vestibular rehabilitation therapy?


Vestibular rehabilitation therapy offers several advantages for individuals with vestibular disorders or balance dysfunctions. Here are some of the key advantages of vestibular rehabilitation therapy:


Symptom Reduction: Vestibular rehabilitation therapy aims to alleviate symptoms such as dizziness, vertigo, imbalance, and unsteadiness. By targeting the underlying causes of these symptoms and promoting compensation and adaptation within the vestibular system, the therapy can help reduce the frequency and intensity of these troubling sensations.


Improved Balance and Stability: One of the primary goals of vestibular rehabilitation therapy is to enhance balance and stability. Through a combination of balance training exercises, coordination activities, and strengthening exercises, individuals can improve their ability to maintain an upright posture, perform daily activities with greater confidence, and reduce the risk of falls.


Functional Improvement: Vestibular disorders can significantly impact an individual's ability to engage in daily activities, work, and social interactions. Vestibular rehabilitation therapy focuses on improving functional abilities by addressing specific limitations and challenges related to balance and spatial orientation. As a result, individuals can regain independence, resume normal activities, and improve their overall quality of life.


Adaptation and Compensation: The brain can remarkably adapt and compensate for vestibular dysfunction. Vestibular rehabilitation therapy utilizes exercises and techniques that promote this adaptive process. By stimulating and challenging the vestibular system through specific movements and activities, the brain can learn to rely on other sensory cues and effectively compensate for the impaired function of the vestibular system.


Customised Approach: Vestibular rehabilitation therapy is highly individualized. Each treatment plan is tailored to the individual's unique needs, symptoms, and goals. The therapy takes into account the specific vestibular disorder, the person's overall health, and any coexisting conditions. This personalized approach ensures the therapy is targeted and optimized for the individual's situation.


Long-Term Benefits: The benefits of vestibular rehabilitation therapy can extend beyond the treatment period. Through the training and exercises provided during therapy, individuals can develop skills and strategies that can be incorporated into their daily lives. These learned techniques, along with improved balance and adaptation, can continue to provide benefits and help individuals manage their symptoms effectively in the long term.


It's important to consult with a healthcare professional specializing in vestibular rehabilitation to determine if this therapy is suitable for your specific condition. They can assess your symptoms, provide an accurate diagnosis, and guide you through vestibular rehabilitation therapy's potential advantages and expected outcomes.


What are the risks of vestibular rehabilitation therapy?


Vestibular rehabilitation therapy is generally considered safe and well-tolerated. However, as with any form of therapy or treatment, there are a few potential risks and considerations to be aware of. These include:


Temporary Increase in Symptoms: In some cases, certain exercises or movements performed during vestibular rehabilitation therapy may temporarily increase symptoms such as dizziness or vertigo. This is known as symptom exacerbation. It typically occurs during the initial stages of therapy as the vestibular system is being stimulated and challenged. However, these temporary increases in symptoms are generally considered a normal part of the rehabilitation process and often subside with continued therapy.


Fatigue and Discomfort: Some individuals may experience fatigue or muscle soreness as a result of the exercises and activities performed during vestibular rehabilitation. This can be due to the physical exertion involved in balance training or other exercises. It is important to communicate any discomfort or excessive fatigue to the healthcare professional overseeing your therapy so that adjustments can be made as needed.


Fall Risk: During balance training exercises or when performing challenging movements, there is a potential risk of falls, particularly for individuals with significant balance impairments. It is crucial to perform these exercises under the guidance and supervision of a healthcare professional trained in vestibular rehabilitation to ensure safety and minimize the risk of injury.


Uncommon Adverse Reactions: Although rare, there are potential risks of adverse reactions to specific treatment techniques or exercises used in vestibular rehabilitation therapy. These reactions may include nausea, headache, or visual disturbances. It is important to promptly inform your healthcare provider if you experience any unusual or concerning symptoms during or after therapy sessions.


It's important to note that the risks associated with vestibular rehabilitation therapy are generally minimal compared to the potential benefits. The therapy is typically well-tolerated and has been shown to be effective in improving symptoms and functional outcomes for individuals with vestibular disorders.


Before initiating vestibular rehabilitation therapy, consulting with a healthcare professional experienced in vestibular rehabilitation is essential. They will evaluate your specific condition, discuss potential risks, and ensure the therapy is appropriate and safe for your needs.


What is the role of cognitive behaviour therapy in vestibular rehabilitation?


Cognitive-behavioral therapy (CBT) can support vestibular rehabilitation by addressing the psychological and emotional factors associated with vestibular disorders. While vestibular rehabilitation primarily focuses on the physical aspects of balance and symptom management, CBT targets the cognitive and behavioral aspects of the condition. Here's how CBT can be beneficial in vestibular rehabilitation:


Anxiety and Fear Reduction: Vestibular disorders often lead to feelings of anxiety, fear, and uncertainty, particularly during episodes of dizziness or vertigo. CBT techniques, such as cognitive restructuring and relaxation strategies, can help individuals manage anxiety and reduce fear associated with vestibular symptoms. By challenging and modifying negative thought patterns, individuals can gain a sense of control and reduce the impact of anxiety on their daily functioning.


Coping Strategies: CBT can assist individuals in developing effective coping strategies to manage the challenges and limitations imposed by vestibular disorders. This may involve identifying and modifying maladaptive thoughts or behaviors related to the vestibular symptoms. Through techniques like problem-solving skills, graded exposure, and activity pacing, individuals can gradually increase their tolerance for activities that provoke symptoms and build confidence in their ability to cope.


Psychological Adjustment: Living with a vestibular disorder can significantly impact an individual's psychological well-being. CBT can facilitate adjustment and acceptance of the condition by addressing issues related to self-esteem, body image, and perceived limitations. Individuals can develop a more positive mindset and improve their overall psychological well-being by challenging negative beliefs and focusing on strengths and adaptive coping.


Sleep and Fatigue Management: Vestibular disorders can disrupt sleep patterns and contribute to fatigue. CBT techniques, such as sleep hygiene education, relaxation exercises, and cognitive restructuring of sleep-related thoughts, can help individuals develop healthier sleep habits and improve overall restfulness. This, in turn, can enhance energy levels and reduce fatigue associated with vestibular symptoms.


Treatment Adherence and Motivation: CBT can also support treatment adherence and motivation in vestibular rehabilitation. By addressing potential barriers, enhancing motivation, and promoting positive reinforcement for engaging in therapy exercises and activities, individuals may be more likely to adhere to their vestibular rehabilitation program and experience improved outcomes.


It's important to note that CBT in vestibular rehabilitation is typically provided by mental health professionals, such as psychologists or therapists trained in CBT techniques. Collaborative care between vestibular rehabilitation therapists and mental health professionals can ensure a comprehensive and holistic approach to the management of vestibular disorders.


If you are undergoing vestibular rehabilitation and believe CBT could benefit your psychological well-being and adjustment, discuss your interest with your healthcare provider. They can provide appropriate referrals and coordinate your care to incorporate CBT into your overall treatment plan.

Mr Gaurav Kumar 

Ear, Nose & Throat Consultant

Consulting at Spire London East, Spire Hartswood Brentwood, Nuffield Health Brentwood and Queens Hospital Romford East London. 

We are also offering Telephone consultations. 

To book an appointment, visit 

Phone Number: 07494914140 

Disclaimer: For general information only, always seek medical advice from your treating consultant. 

Read more about ENT Conditions at

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