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The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma

  • Silvie HrubáEmail author
  • Martin Chovanec
  • Zdeněk Čada
  • Zuzana Balatková
  • Zdeněk Fík
  • Kryštof Slabý
  • Eduard Zvěřina
  • Jan Betka
  • Jan Plzak
  • Ondřej Čakrt
Otology
  • 37 Downloads

Abstract

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.

Keywords

Vestibular schwannoma Compensation Rehabilitation Prehabilitation Posturography Subjective visual vertical 

Notes

Acknowledgements

The study was supported by the First faculty of Charles University, project GA UK number 310216.

Compliance with ethical standards

Conflict of interest

Authors have no competing interests to declare.

Ethical approval

The study protocol was approved by the local ethical committee.

Informed consent

All participants gave their oral informed consent documented in the medical records.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of MedicineCharles University and University Hospital Motol, Postgraduate Medical SchoolPragueCzech Republic
  2. 2.Department of Rehabilitation and Sports Medicine, 2nd Faculty of MedicineCharles University and University Hospital MotolPragueCzech Republic
  3. 3.Department of Otorhinolaryngology, 3rd Faculty of MedicineUniversity Hospital Kralovské Vinohrady, Charles UniversityPragueCzech Republic

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