Before Your First Vestibular Rehabilitation Visit: Symptom Diary, Hearing Tests and Medicines

She rolled over in bed to silence the alarm and the ceiling slid sideways. Twenty seconds, maybe less, then stillness, then the slow dread of knowing it would happen again the next time she lay down. The referral letter arrived a week later, two lines long, with a phone number and the words “vestibular rehabilitation.” No explanation of what the first visit involves or what she should carry through the door.

That gap is what this article fills. A vestibular rehabilitation first appointment is less like a treatment session and more like a careful interview with a physical examination attached. The therapist wants to know your dizziness in detail: its timing, its triggers, what your ears have been doing, and which medicines are already in your system.

Arrive with those three pieces prepared and the visit changes character. Instead of reconstructing three months of spinning from memory while your head still feels unsteady, you hand over a record and the conversation starts where it should.

What happens at a vestibular rehabilitation first appointment?

Expect talking before moving. A vestibular physical therapist, a physiotherapist trained in the balance system of the inner ear and brain, will spend the opening stretch on history. When did the dizziness begin? Does the room spin, or do you feel unsteady, foggy, or as if you might faint? Does turning in bed set it off, or does it arrive out of nowhere and last for hours? Each answer narrows the field, because the pattern of dizziness points to different parts of the system.

The examination comes next, and it looks strange if you have never seen it. The therapist watches your eyes while your head is still, then while it moves. Jerking eye movements, called nystagmus, are an outward sign of what the inner ear is telling the brain, and their direction and timing are diagnostic gold. You may be asked to follow a finger, to keep your gaze on a target while your head is turned quickly, and to lie back with your head tilted in a specific way. That last maneuver is the Dix-Hallpike test, which the Mayo Clinic describes as the standard way to check for benign paroxysmal positional vertigo, or BPPV, the most common cause of vertigo.

Balance is assessed on firm ground and on foam, with eyes open and closed. Your walking pattern is watched, sometimes while you turn your head or count backward. None of this is a pass-or-fail exam; it is a map of which sensory inputs your brain is leaning on and which it has stopped trusting.

By the end, most therapists explain what they found, outline a working plan and often teach one or two starting exercises. If the Dix-Hallpike test is positive, a repositioning maneuver may happen on the spot. The whole visit commonly runs longer than a routine physiotherapy session, so allow for it.

How vestibular rehabilitation actually works

The inner ear contains two systems packed into a bony space smaller than a sugar cube. One is the cochlea, which hears. The other is the vestibular labyrinth: three fluid-filled semicircular canals that sense rotation, and two small organs, the utricle and saccule, that sense gravity and straight-line movement. Signals from both ears travel to the brainstem, where they are compared with what the eyes see and what the joints and feet report.

Dizziness usually arises when those reports disagree. A damaged left ear sends weaker signals than the right, and the brain reads the imbalance as spinning even when you are standing still. Vestibular rehabilitation does not repair the ear. It retrains the brain to recalibrate around the new signal, a process called central compensation.

Three mechanisms do most of the work, and the Cleveland Clinic describes each in its overview of vestibular rehabilitation. Adaptation exercises use head movement while you fix your gaze on a target, teaching the reflex that steadies your vision to adjust its gain. Habituation deliberately repeats the movements that provoke your symptoms, in small controlled doses, so the brain gradually stops sounding the alarm. Substitution training strengthens the other balance inputs, vision and body sense, so they can pick up more of the load.

BPPV is the exception. There, tiny calcium carbonate crystals have drifted from the utricle into a semicircular canal, and the National Institute on Deafness and Other Communication Disorders explains that repositioning maneuvers, such as the Epley maneuver, use gravity to guide them back where they belong. That is mechanical, not neural, which is why it can work quickly.

The practical consequence is worth stating plainly: compensation requires the brain to receive the mismatched signal and practice with it. Avoiding every movement that makes you dizzy feels protective, but it starves the brain of the very information it needs to adjust.

Who vestibular rehab is usually for, and who is usually asked to wait

The clearest candidates are people whose dizziness comes from a stable problem in one or both inner ears. That includes BPPV, the aftermath of vestibular neuritis or labyrinthitis (inflammation of the balance nerve or the inner ear itself, often following a viral illness), and the persistent unsteadiness that can follow a head injury or certain ear surgeries. The NHS notes that most people recover from vestibular neuritis over a few weeks, but a proportion are left with lingering imbalance, and that lingering group is where therapy earns its place.

Age is not a barrier. Older adults with multiple contributors to imbalance, weaker ankles, dimmer vision and a slower inner ear, often benefit from the substitution and balance components even when no single cause is found. Persistent postural-perceptual dizziness, a chronic sense of rocking or swaying that persists after an initial vestibular event, is also commonly referred.

Some people are asked to wait, and the reasons are sensible rather than dismissive.

• Active Meniere’s disease, with fluctuating hearing and unpredictable attacks, is a moving target; therapy works better once the medical team has the attacks under some control.
• An acute episode of vestibular neuritis in its first few days is dominated by nausea and severe spinning, which the NHS describes as typically worst in the first days before easing; therapy usually begins as that settles.
• Dizziness with unexplained neurological features, new severe headache, double vision or weakness, needs medical assessment first, because the cause may lie in the brain rather than the ear.
• Untreated cardiac or blood pressure causes of lightheadedness will not respond to inner-ear exercises.

None of these are permanent exclusions. The referring physician and therapist decide together when the timing is right, and that decision rests with them.

How to keep a symptom diary your therapist can actually use

Memory flattens dizziness into a single word: bad. A diary restores the texture. Two weeks of entries, even rough ones, tell a therapist more than an hour of recollection, because the pattern of episodes is what distinguishes one vestibular condition from another.

Duration is the single most useful column. The Mayo Clinic describes BPPV episodes as typically lasting less than a minute; the NHS describes labyrinthitis and vestibular neuritis producing symptoms that persist for days before gradually easing; Meniere’s attacks characteristically last hours. Write down the clock time when spinning started and when it stopped, not an impression afterward.

Beyond duration, capture these for each episode:

• What you were doing in the seconds before: rolling over, looking up at a shelf, standing from a chair, walking down a supermarket aisle.
• The quality of the sensation, in your own words: spinning, tilting, rocking, floating, about-to-faint, or head fog.
• Anything in the ears: ringing, fullness, muffled hearing, or a change in one ear compared with the other.
• Companions: nausea, vomiting, headache, visual disturbance, sweating, palpitations.
• Medicines taken that day, including anything over the counter, and roughly when.
• Sleep the night before, caffeine and alcohol, menstrual cycle if relevant, and stress level, all of which can lower the threshold for symptoms.
• Any stumble, near-fall or fall, however minor.

Keep it honest and brief. A line per episode is enough. A phone note works as well as a notebook, and a photograph of the page can be shared before the visit if the clinic allows. Between episodes, a single daily rating of overall steadiness from zero to ten gives the therapist a baseline to measure change against later.

One caution: a diary is a record, not a diagnostic tool. Resist the temptation to match your pattern to an internet list and arrive with a conclusion. Bring the data and let the team interpret it.

Why a hearing test for dizziness is often ordered before therapy

It puzzles many people that a balance referral generates an appointment with an audiologist. The logic sits in anatomy. Hearing and balance share the same fluid, the same nerve bundle and the same blood supply inside the temporal bone. When the inner ear is injured, the cochlea and the labyrinth frequently suffer together, and a hearing test is one of the few objective windows onto that shared space.

The distinction it draws can change the diagnosis. The NHS separates labyrinthitis from vestibular neuritis largely on this basis: labyrinthitis affects hearing as well as balance, while vestibular neuritis spares hearing. Meniere’s disease produces a characteristic low-frequency hearing loss that fluctuates with attacks. A one-sided hearing loss that has crept in slowly, alongside unsteadiness, prompts a different line of investigation entirely.

A standard audiogram takes roughly half an hour. You sit in a sound-treated booth wearing headphones and press a button or raise a hand when you hear tones at different pitches and volumes, then repeat a set of words. Some clinics add tympanometry, a quick test of how the eardrum moves, and speech-in-noise testing. Nothing about it hurts, and no preparation beyond clean ears is needed; if you suspect wax, mention it when booking.

Bring the printed audiogram, or ensure it has been sent, to your vestibular rehabilitation first appointment. The therapist reads the shape of the graph the way a cardiologist reads an ECG trace: a notch at one frequency, an asymmetry between ears, or a perfectly normal result each redirects the plan. A normal hearing test is not a wasted test. It rules out a set of conditions and lets the team focus on the ones that remain.

Vestibular testing preparation: which tests you may face and what they measure

Not everyone needs formal vestibular testing before therapy. When the history and bedside examination are clear, many therapists begin treatment on the first visit. When the picture is murkier, or when the referring physician wants to quantify how much each ear is contributing, a battery of tests may be scheduled first. Knowing what each one measures removes most of the anxiety.

Test	What it measures	What it feels like
Videonystagmography (VNG)	Eye movements while tracking targets and during head positioning; detects nystagmus patterns	Goggles with infrared cameras record your eyes in a dim room; some positions may provoke brief dizziness
Caloric testing (part of VNG)	How each ear’s horizontal canal responds when warm and cool air or water is introduced	A short spinning sensation lasting a minute or two; the strongest part of the battery for many people
Video head impulse test (vHIT)	The reflex linking each semicircular canal to the eyes, canal by canal	Quick, small, unpredictable head turns while you stare at a dot; usually not provoking
Vestibular evoked myogenic potentials (VEMP)	The gravity-sensing organs (utricle and saccule) and their nerve pathways	Loud clicks through earphones while neck or eye muscles are tensed; electrodes on skin
Rotary chair	Both ears together, at frequencies of movement closer to daily life	Sitting in a motorized chair that turns slowly in the dark
Posturography	How much you rely on vision, inner ear and body sense to stay upright	Standing on a platform that may tilt, with a visual surround that may move

Sessions vary in length depending on which tests are ordered; ask the booking office for an estimate rather than assuming. Results go to the referring physician and therapist, who interpret them alongside your diary and hearing test. No single test diagnoses a vestibular disorder on its own, and a normal battery does not mean your symptoms are imaginary; it means the problem lies somewhere the tests do not reach, which is itself useful information.

What not to do before vestibular testing

Testing centers send written instructions, and those instructions override anything general. Read them twice, because a test performed on the wrong preparation may need repeating.

The consistent themes across centers are these. Alcohol is commonly asked to be avoided for a day or two beforehand, because it directly alters inner-ear fluid and eye movements and can mimic or mask a disorder. Caffeine is often restricted on the day, since it can sharpen or dampen the responses being measured. Heavy meals close to the appointment are discouraged; some positions provoke nausea, and an empty-ish stomach is more comfortable than a full one. A light breakfast is usually fine.

Eye makeup, false lashes and heavy face creams interfere with the infrared cameras inside VNG goggles, so arrive with a clean face. Contact lenses may need to come out; bring your glasses and a lens case. Wear low-heeled, closed shoes and clothing you can lie down and turn in.

Medicines deserve their own paragraph, because this is where people get anxious. Certain drug classes, including sedating antihistamines, some anti-nausea medicines, sedatives and muscle relaxants, suppress the vestibular responses that testing is trying to record. Centers therefore frequently ask patients to review those medicines with the prescribing clinician before the test. That review is a conversation between you and the prescriber. Do not stop or skip anything on your own initiative, particularly medicines for the heart, blood pressure, seizures, mood or diabetes, none of which are typically affected and all of which carry risks if interrupted.

Finally, arrange transport. The caloric portion in particular can leave people wobbly for a short while afterward, and driving straight from the booth is a poor idea. A companion who can also listen to the results explanation is worth more than a taxi.

Medicines and vestibular rehab: what to tell your team

Bring a complete list, with names and how often you take each, including supplements, sleep aids and anything bought without a prescription. The therapist is not going to change any of it. They need to understand how the chemistry in your body may be shaping what they observe and how quickly your brain can adapt.

The most relevant category is vestibular suppressants. These are medicines, usually antihistamines or certain anti-nausea drugs, that dampen signals from the inner ear or the brain’s vomiting center. In the first days of a vestibular neuritis attack they can be a mercy, and the NHS notes that a doctor may prescribe them for short-term relief of severe symptoms, typically for no more than a few days. The mechanism that makes them helpful early is exactly what makes them awkward later: compensation requires the brain to notice the mismatch between the ears, and a medicine that mutes the mismatch slows the learning. This is why prescribers generally keep such courses short, and why a therapist who sees a suppressant on your list weeks after the acute phase will often suggest a conversation with the prescriber. The suggestion is a prompt, not an instruction.

Other classes matter in quieter ways. Sedatives and some antidepressants can blunt alertness and balance reactions. Blood pressure medicines can cause lightheadedness on standing that sits alongside, and gets confused with, inner-ear vertigo. Certain antibiotics and chemotherapy agents are known to be toxic to the inner ear, and a history of them changes the diagnostic picture. Even a recent course of steroids for neuritis is worth noting, since it marks where you are in the recovery timeline.

If you have questions about whether a medicine is helping or hindering, write them down and raise them with the person who prescribed it. The therapist can supply observations; the prescriber weighs those against everything else that medicine is doing for you.

What do they do in vestibular rehab? The exercises explained

People imagine machines. Mostly it is you, a chair, a wall and a piece of paper with a letter on it.

Gaze stabilization is usually first. You fix your eyes on a target at arm’s length and turn your head side to side, then up and down, keeping the letter sharp. Early on it blurs and your stomach objects; over days the reflex adjusts and the letter stays still. The Cleveland Clinic describes this as the core of adaptation training, and progressions add a busy background, a moving target or standing on foam.

Habituation exercises are prescribed when specific movements reliably trigger symptoms. You perform the provoking movement, bending forward to touch the floor, say, or turning quickly in a supermarket aisle, a set number of times, stop, let the dizziness fade, and repeat later in the day. The dose is deliberately uncomfortable but tolerable. The principle is the same one that lets a sailor stop noticing the deck.

Balance and gait training builds the substitution side. Standing with feet together, then heel to toe, then on one leg; eyes open, then closed; on the floor, then on a cushion. Walking with head turns, walking while reading a card, stepping over lines. Each variation removes one source of information and forces the others to work harder.

Repositioning maneuvers apply only to BPPV. The therapist guides your head through a sequence of positions, holding each until any spinning subsides, to move the loose crystals out of the canal. The NIDCD describes these maneuvers as the standard approach for BPPV, and many people need only one or two sessions of them.

Home practice carries most of the load. A typical prescription is short bouts several times a day rather than one long session, because frequent exposure drives compensation better than occasional heroics. Your therapist will write the plan down; ask for it in a form you can stick on the fridge.

How long does vestibular rehab take?

It depends on what is wrong, and honest teams say so on day one. The Cleveland Clinic gives a commonly quoted frame: many people attend once or twice a week for roughly six to eight weeks, with daily home exercises in between. Treat that as a typical range from a mainstream source, not a schedule you will personally follow.

The spread around that average is wide. Uncomplicated BPPV sits at the short end; the Mayo Clinic notes that repositioning maneuvers often resolve symptoms within a session or two, though the condition can recur and a top-up may be needed. A single stable inner-ear injury, such as the residual imbalance after vestibular neuritis, tends to follow the several-week pattern, because the brain needs repeated exposure to recalibrate. Chronic persistent postural-perceptual dizziness, bilateral vestibular loss, or dizziness layered onto migraine, anxiety or a head injury generally take longer and progress in steps rather than a smooth line.

Several factors are known to lengthen the road. Long-term use of vestibular suppressants slows compensation, for the mechanistic reason described earlier. Avoiding movement, understandable as it is, delays the brain’s exposure to the signals it must learn from. Poor sleep, uncontrolled migraine and high anxiety each lower the threshold for symptoms and can mask genuine progress. Age alone is not a strong predictor; older adults compensate, sometimes more slowly, but they do compensate.

Progress is measured, not guessed. Most therapists repeat one or two standardized balance or dizziness questionnaires every few weeks and compare them with your first-visit scores. Ask which measures are being tracked and what a meaningful change looks like. If the numbers plateau, that is a signal to revisit the diagnosis or the plan, not evidence that you have failed.

Discharge usually comes with a maintenance routine and clear instructions on what would warrant a return.

Is it normal to feel worse after vestibular therapy? The first days and weeks

Yes, within limits, and knowing the shape of it in advance keeps people from quitting in week two.

The first appointment itself often provokes symptoms. Positional testing and any repositioning maneuver deliberately stir the system, and a wave of nausea or unsteadiness for the rest of the day is common. The Cleveland Clinic states directly that vestibular exercises can temporarily increase dizziness, and that this is expected rather than a sign of harm. Plan a quiet afternoon after visit one, avoid driving if you feel off, and eat lightly.

The first week of home exercises follows a familiar arc. Each set of gaze stabilization or habituation movements produces a spike of symptoms that fades over minutes. Across the week the spikes get shorter and lower, though the improvement is rarely smooth. A bad night’s sleep, a head cold or a stressful day can erase two days of gains, and then they come back.

By the second and third weeks, many people notice they can do the exercises with less dread and are turning their head more freely in daily life without thinking about it. Movements they had quietly stopped doing, looking up to a top shelf, checking a blind spot, start creeping back. This is compensation working.

The useful rule of thumb therapists teach is about recovery time, not intensity. Symptoms provoked by an exercise should settle within a short period afterward, commonly described as a matter of minutes to under half an hour. If a set leaves you unwell for hours, or if each day is worse than the last rather than the same or slightly better, the dose is too high and your therapist needs to hear about it. That is an adjustment, not an abandonment.

Symptoms that are entirely new, rather than a louder version of the familiar ones, are a different matter and belong in the red-flag section below.

What to expect at vestibular therapy on the day: a practical checklist

Small logistics smooth a visit that can feel unsteady in every sense.

Wear clothes you can lie flat in and turn over without adjustment; the Dix-Hallpike test and any repositioning maneuver involve lying back quickly with your head hanging slightly over the edge of a table. Flat, closed shoes with a grippy sole make the balance assessment safer and more accurate than sandals or boots. If you use a cane, walker or hearing aids, bring them; the therapist wants to see you as you actually move through the world.

Glasses matter more than people expect. Bifocals and progressive lenses alter how the brain reads the ground, and a therapist may want to test you with and without them. Contact lens wearers should bring a case and glasses in case the eyes need to be observed directly.

Have a companion if you can. Not because the visit is dangerous, but because you may feel unwell afterward and because a second set of ears catches instructions that a dizzy brain lets slip. Ask in advance whether the clinic allows someone in the room.

Paperwork to carry: your symptom diary, the hearing test result if you have a copy, the medication list, and any letters or imaging reports from the referring physician. A short written list of your own questions saves you from the walk-to-the-car realization that you forgot the important one.

Eat something light beforehand and skip the double espresso; an empty stomach makes nausea worse, a full one makes it messier, and caffeine can sharpen the spinning. Arrive a few minutes early so you are not rushing down a corridor with your head turning, which is exactly the kind of movement that sets things off.

What people often get wrong about vestibular rehabilitation

Misconceptions cluster around this treatment, partly because dizziness is invisible and partly because the therapy asks for something counterintuitive.

“Resting until it passes is the safest plan.” For the first days of an acute attack, rest is reasonable. Beyond that, the brain compensates only by receiving the mismatched signal and practicing with it. Prolonged avoidance is one of the best-documented reasons people stay dizzy for months. Movement, graded and deliberate, is the treatment.

“The exercises made me dizzy, so they must be harming my ear.” The symptoms provoked by therapy are a sign the exercise is reaching the system, not damaging it. The inner ear is not injured by turning your head. What matters is that symptoms settle afterward and the trend improves.

“A normal test means it’s all in my head.” Current tests measure specific parts of the vestibular system at specific frequencies. A normal battery excludes some conditions and leaves others, including migraine-related dizziness and persistent postural-perceptual dizziness, which are real, common and respond to targeted approaches.

“Vertigo is a diagnosis.” Vertigo is a symptom, the illusion of movement. The NHS lists more than a dozen causes, from BPPV to migraine to medication effects. Therapy differs by cause, which is why the diary and tests matter.

“One repositioning maneuver fixes BPPV for good.” It often relieves the current episode. The Mayo Clinic notes that BPPV can recur, sometimes months or years later, and a repeat maneuver is then reasonable. Recurrence is not failure.

“I can find the exercises online and skip the assessment.” The exercise that helps one canal can provoke another, and a habituation routine designed for someone else may target movements that are not your problem. The assessment is what makes the exercises specific.

“Older people are too unsteady to do this.” Balance training for older adults is, if anything, more valuable, because falls carry more consequence. Programs are scaled to the person.

Questions to ask your care team at the first visit

A dizzy brain forgets its questions. Write these down, cross out the ones that do not fit, and bring the page.

• Based on today, what do you think is the most likely source of my dizziness, and how confident are you?
• Do I need formal vestibular testing or a hearing test before we proceed, and if so, what specifically will each add?
• Which of my current medicines might affect how I respond to therapy, and should I raise any of them with the person who prescribed them?
• What exercises am I to do at home, how often, and what does a correct set look like? Can you watch me do one before I leave?
• How much dizziness during exercises is expected, and how long should it take to settle afterward? What would tell me the dose is too high?
• Which measures will you use to track my progress, and when will we review whether the plan is working?
• Roughly how many visits do people with a similar picture usually need, understanding that it varies?
• Are there activities I should continue, such as driving, exercise or work tasks involving heights or ladders, and any I should pause for now?
• If this is BPPV, what are the chances it comes back, and what should I do if it does?
• What symptoms would mean I should stop the exercises and contact you or my physician urgently?
• Is there anything in my hearing test or referral letter that changes the plan, or that you want the referring physician to look at again?
• Who do I contact between appointments if something changes, and how quickly can I expect a reply?

The answers you are looking for are specific rather than reassuring. A therapist who says “it varies, but here is how we will know” is giving you a better answer than one who promises a timeline.

When to call your doctor: red-flag signs that need urgent attention

Most dizziness comes from the ear and is unpleasant rather than dangerous. A small proportion comes from the brain, the heart or the blood vessels, and the features that separate the two are well described by MedlinePlus, the NHS and the Mayo Clinic. Seek emergency care immediately, rather than waiting for your therapy appointment, if dizziness arrives with any of the following:

• Sudden severe headache unlike any you have had before.
• Weakness, numbness or drooping on one side of the face or body.
• Slurred speech, difficulty swallowing, or trouble finding or understanding words.
• Double vision, sudden loss of vision, or a visual field cut.
• Inability to stand or walk when you could previously, out of proportion to the spinning.
• Chest pain, palpitations, shortness of breath, or fainting.
• Confusion, unusual drowsiness or a seizure.
• Dizziness following a head injury, a fall with head strike, or a neck injury.
• Sudden hearing loss in one ear, especially with the onset of vertigo, which needs prompt medical assessment.
• A stiff neck with fever, or a rash.

Contact your physician or therapist promptly, though not necessarily as an emergency, if symptoms change character during your rehabilitation course: an entirely new type of dizziness, a new persistent headache, ear pain or discharge, exercises that leave you unwell for hours rather than minutes, or a fall at home. Persistent vomiting that prevents you from keeping fluids down also warrants a same-day call.

Vertigo that is severe and constant for more than a day or two without easing, particularly if it did not begin with a clear positional trigger, should be reassessed by a physician even if you are already booked for therapy. The NHS advises seeking medical review when dizziness does not improve or keeps returning, and that advice stands throughout treatment.

Every decision about testing, medicines and the pace of therapy belongs to your treating team. This article prepares you for the conversation; it does not replace it.

Frequently asked questions

How long does vestibular rehab take from the first appointment to discharge?

A commonly cited range from the Cleveland Clinic is one to two sessions a week for roughly six to eight weeks, with daily home exercises in between. The real answer varies by cause: BPPV often resolves in one or two repositioning sessions, residual imbalance after vestibular neuritis usually follows the several-week pattern, and chronic or multifactorial dizziness can take longer. Your therapist should track standardized measures and revisit the plan if progress stalls.

What should I not do before vestibular testing?

Follow the written instructions from your testing center first. Commonly, patients are asked to avoid alcohol for a day or two, limit caffeine on the day, skip heavy meals, and arrive without eye makeup or heavy face creams because they interfere with the goggle cameras. Certain sedating medicines can suppress test responses, so centers often ask you to review them with your prescriber beforehand. Do not stop any prescribed medicine on your own.

Is it normal to feel worse after vestibular therapy?

Yes, a temporary increase in dizziness during and shortly after exercises is expected and is described by mainstream sources as part of how the brain recalibrates. Symptoms provoked by a set should settle within minutes, and the overall trend across a week or two should improve. If each day is worse than the last, or a session leaves you unwell for hours, tell your therapist so the dose can be adjusted.

What do they do in vestibular rehab?

Most of it is simple movement done precisely. Gaze stabilization has you keep your eyes on a target while moving your head; habituation repeats the specific movements that trigger your symptoms in controlled doses; balance and gait training challenges you on foam or with eyes closed. For BPPV, the therapist performs repositioning maneuvers that guide loose inner-ear crystals back into place. Daily home practice does most of the work between visits.

What is a vestibular rehabilitation first appointment like?

It is mostly an interview followed by a hands-on examination. The therapist takes a detailed history of your dizziness, watches your eye movements with your head still and moving, performs positional tests such as the Dix-Hallpike maneuver, and assesses your standing balance and walking. You usually leave with an explanation of the findings, a working plan and one or two starting exercises, and sometimes a repositioning maneuver has already been done.

Why do I need a hearing test for dizziness?

Because hearing and balance organs sit together in the inner ear and share the same nerve and blood supply. A hearing test helps separate conditions: labyrinthitis affects hearing and balance, vestibular neuritis spares hearing, and Meniere’s disease produces a characteristic fluctuating low-frequency loss. A normal result is still useful, since it rules out several causes and lets the team focus on those that remain.

Should I stop my dizziness medicine before starting vestibular rehab?

Not without speaking to the person who prescribed it. Vestibular suppressants, such as some antihistamines and anti-nausea medicines, dampen the inner-ear signals that the brain needs to practice with, which is why they are usually prescribed for only a few days during an acute attack. Your therapist may suggest you raise the question with your prescriber, but any change to timing or use is that clinician’s decision.

What should I include in a dizziness symptom diary?

For each episode, record the clock time it started and stopped, what you were doing just before, the quality of the sensation in your own words, any ear symptoms such as ringing or fullness, companions like nausea or headache, medicines taken that day, and any stumble or fall. Add a daily steadiness rating from zero to ten. Two weeks of brief entries is usually more useful than a long retrospective account.

What is the Dix-Hallpike test and does it hurt?

It is a positional test used to check for BPPV. The therapist turns your head to one side and helps you lie back quickly so your head hangs slightly below the table, then watches your eyes for a characteristic jerking movement. It does not hurt, but if you have BPPV it will usually provoke a brief spell of spinning that fades within a minute. That reaction is the point of the test.

Can vestibular rehabilitation help older adults with unsteadiness and falls?

Yes, and older adults are among the most common people referred. Balance in later life often depends on several weaker inputs at once, so the substitution and gait-training components of vestibular rehabilitation are particularly relevant. Programs are scaled to the individual and progress in small steps. Age itself is not considered a barrier to compensation, though the pace may be slower and the number of sessions higher.

References

• Cleveland Clinic: Vestibular Rehabilitation
• NHS: Vertigo
• NIH National Institute on Deafness and Other Communication Disorders: Balance Disorders
• MedlinePlus: Dizziness and Vertigo

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.