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



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.


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.


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.


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.


Vestibular schwannoma Compensation Rehabilitation Prehabilitation Posturography Subjective visual vertical 



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.


  1. 1.
    Zverina E (2010) Acoustic neuroma–vestibular schwannoma–personal experience of up-to-date management. Cas Lek Cesk 149(6):269–276Google Scholar
  2. 2.
    Enee V, Guerin J, Bebear JP, Darrouzet V (2003) Acoustic neuroma surgery. Results and complications in 348 cases. Rev Laryngol Otol Rhinol 124(1):45–52Google Scholar
  3. 3.
    Betka J, Zverina E, Balogova Z, Profant O, Skrivan J, Kraus J, Lisy J, Syka J, Chovanec M (2014) Complications of microsurgery of vestibular schwannoma. Biomed Res Int 2014:315952. CrossRefGoogle Scholar
  4. 4.
    Parietti-Winkler C, Gauchard GC, Simon C, Perrin PP (2006) Sensorimotor postural rearrangement after unilateral vestibular deafferentation in patients with acoustic neuroma. Neurosci Res 55(2):171–181. CrossRefGoogle Scholar
  5. 5.
    Lacour M, Bernard-Demanze L (2014) Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery. Front Neurol 5:285. Google Scholar
  6. 6.
    Perez N, Santandreu E, Benitez J, Rey-Martinez J (2006) Improvement of postural control in patients with peripheral vestibulopathy. Eur Arch Otorhinolaryngol 263(5):414–420. CrossRefGoogle Scholar
  7. 7.
    Enticott JC, O'Leary SJ, Briggs RJ (2005) Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery. Otol Neurotol 26(2):265–269CrossRefGoogle Scholar
  8. 8.
    Cakrt O, Chovanec M, Funda T, Kalitova P, Betka J, Zverina E, Kolar P, Jerabek J (2010) Exercise with visual feedback improves postural stability after vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 267(9):1355–1360. CrossRefGoogle Scholar
  9. 9.
    Balatková ZČR, Fík Z, Hrubá S, Čakrt O, Zvěřina E, Betka J, Plzák J, Čada Z (2018) Faktory ovlivňující vestibulární kompenzaci u pacientů po operaci vestibulárního schwannomu. Otorinolaryngie a Foniatrie 67(4):91–94Google Scholar
  10. 10.
    Magnusson M, Kahlon B, Karlberg M, Lindberg S, Siesjo P, Tjernstrom F (2009) Vestibular “PREHAB”. Ann N Y Acad Sci 1164:257–262. CrossRefGoogle Scholar
  11. 11.
    Magnusson M, Kahlon B, Karlberg M, Lindberg S, Siesjo P (2007) Preoperative vestibular ablation with gentamicin and vestibular ‘prehab’ enhance postoperative recovery after surgery for pontine angle tumours–first report. Acta Otolaryngol 127(12):1236–1240. CrossRefGoogle Scholar
  12. 12.
    Gardner G, Robertson JH (1988) Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 97(1):55–66. CrossRefGoogle Scholar
  13. 13.
    Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M (2009) A bucket of static vestibular function. Neurology 72(19):1689–1692. CrossRefGoogle Scholar
  14. 14.
    Legters K, Whitney SL, Porter R, Buczek F (2005) The relationship between the activities-specific balance confidence scale and the dynamic gait index in peripheral vestibular dysfunction. Physiother Res Int 10(1):10–22CrossRefGoogle Scholar
  15. 15.
    Prieto TE, Myklebust JB, Hoffmann RG, Lovett EG, Myklebust BM (1996) Measures of postural steadiness: differences between healthy young and elderly adults. IEEE Trans Biomed Eng 43(9):956–966. CrossRefGoogle Scholar
  16. 16.
    Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK (1995) Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg 113(1):77–87. CrossRefGoogle Scholar
  17. 17.
    Cohen HS, Kimball KT, Jenkins HA (2002) Factors affecting recovery after acoustic neuroma resection. Acta Otolaryngol 122(8):841–850CrossRefGoogle Scholar
  18. 18.
    Mruzek M, Barin K, Nichols DS, Burnett CN, Welling DB (1995) Effects of vestibular rehabilitation and social reinforcement on recovery following ablative vestibular surgery. Laryngoscope 105(7 Pt 1):686–692. CrossRefGoogle Scholar
  19. 19.
    Tjernstrom F, Fransson PA, Kahlon B, Karlberg M, Lindberg S, Siesjo P, Magnusson M (2018) PREHAB vs. REHAB—presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: retrospective case series. J Vestib Res 27(5–6):313–325. CrossRefGoogle Scholar
  20. 20.
    Deveze A, Montava M, Lopez C, Lacour M, Magnan J, Borel L (2015) Vestibular compensation following vestibular neurotomy. Eur Ann Otorhinolaryngol Head Neck Dis 132(4):197–203. CrossRefGoogle Scholar
  21. 21.
    Cada Z, Balatkova Z, Chovanec M, Cakrt O, Hruba S, Jerabek J, Zverina E, Profant O, Fik Z, Komarc M, Betka J, Kluh J, Cerny R (2016) Vertigo perception and quality of life in patients after surgical treatment of vestibular schwannoma with pretreatment prehabituation by chemical vestibular ablation. Biomed Res Int 2016:6767216. CrossRefGoogle Scholar

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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