UNILATERAL VESTIBULAR HYPOFUNCTION DECOMPENSATION AFTER COVID-19 INFECTION: A REHABILITATION CASE STUDY

G. Doar¹, A. Weston¹, A. Fangman¹, B. Loyd², L. Dibble¹

¹University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, United States, ²University of Montana, Department of Physical Therapy and Rehabilitation Sciences, Missoula, United States

Background: Surgical removal of a benign vestibular schwannoma results in a unilateral vestibular hypofunction (UVH) with patients reporting substantial dizziness, oscillopsia, and imbalance in the post-operative period. The vestibular lesion is permanent; however, recovery of gaze and postural stability, and reduction of dizziness can occur through vestibular rehabilitation mediated plasticity of the central nervous system. Following post-operative recovery, individuals generally return to high levels of physical function, regularly challenging their gaze and postural stability systems and maintaining a level of habituation that minimizes their complaints of dizziness and imbalance.Interruption of regular vestibular stimuli, such as decreased activity due to illness, can cause decompensation.

Purpose: This case study describes vestibular decompensation due to COVID-19 infection and recovery through vestibular rehabilitation.

Methods: A 49-year-old woman with a history of left vestibular schwannoma resection (VSR) and successful rehabilitation 10 years earlier contracted COVID-19 resulting in 1-week hospitalization necessitating ICU care and supplemental oxygen support. The patient presented to a vestibular physical therapy (VPT) clinic 5 months after COVID diagnosis due to persistent dizziness and imbalance. The following outcome measures were taken at the initial exam, Dizziness Handicap Inventory (DHI) score: 46%, MiniBEST: 19/28, 2-minute walk test (2MW): 158m, video head impulse test (vHIT): right gain 0.93, left gain 0.63. Synthesis of the history and exam findings led to the physical therapy diagnosis of vestibular decompensation resulting in the re-emergence of left sided vestibular hypofunction resulting in postural and gaze stability deficits and moderate disability due to dizziness. The patient completed VPT twice a week for 6 weeks focusing on gaze stabilization, static and dynamic balance exercises, along with complimentary home exercises.

Results: Clinical outcomes at 6-week follow-up demonstrated improvements in the following measures: DHI score: 14%, MiniBEST score: 25/28, 2MW: 275m, vHIT left gain of 0.73. The patient reported improvements in function and reduced disability reporting a return to playing tennis without an increase in symptoms.

Conclusions: Vestibular compensation post-injury is dependent on movement. Decompensation, although rare, can occur with decreased activity resulting in reduced vestibular system stimulation. We hypothesize that acute bed-rest and relative head and neck immobilization due to COVID ICU management prevented this patient from sustaining her long-standing vestibular compensation and resulted in the re-emergence of gaze and postural stability deficits and dizziness handicap similar to what she experienced immediately after VSR. Focused VPT exercises targeted at gaze and postural stability improved dynamic balance, physical function, and reduced complaints of dizziness.

Implications: This case suggests decompensation of vestibular function can occur with abrupt and significant decrease in functional activity, but vestibular rehabilitation was effective in reducing symptoms and facilitating recovery of function. This case study also adds valuable information to the limited literature on vestibular decompensation and treatment.

Funding acknowledgements: MS Society, Foundation for Physical Therapy Research

Keywords:
Vestibular hypofunction
COVID-19
Decompensation

Topics:
COVID-19
Neurology

Did this work require ethics approval? Yes

Institution: University of Utah

Committee: IRB

Ethics number: 125069