Event Title

Differential Diagnosis of the Vestibular System and Effectiveness of a Vestibular Rehabilitation Program Following Radiation Treatment for Tonsil Cancer: A Retrospective Case Report

Start Date

4-12-2019 4:00 PM

End Date

4-12-2019 6:00 PM

Abstract

Background/purpose: Impairments in the vestibular system are a common diagnosis seen in physical therapy today. The most common vestibular diagnosis is Benign Positional Vertigo (BPPV) with vestibular hypofunction occurring second most common. Vestibular hypofunction usually results from neuritis, chronic inflammation of peripheral system, or infection. Previous studies examined the effectiveness of vestibular rehabilitation training on postural stability and gaze stabilization for individuals with bilateral or unilateral vestibular hypofunction but research is limited for vestibular rehabilitation training following radiation treatment. Therefore, the purpose of this retrospective case report is to document the impact of a vestibular rehabilitation program on improving vestibular hypofunction, resulting from neurotoxicity following radiation treatment.

Case Description: The subject was an 88 year old Caucasian female who had reported symptoms including: dizziness, lightheadedness, and “feeling off” when moving her head and changing positions, specifically from supine to sitting. The patient reported symptoms began approximately 3 weeks ago following the end of her last radiation treatment for palatine tonsil cancer in her neck.

Outcomes: The patient was seen by an SPT, supervised by a PT for a total of six visits. Improvements in both the DGI and DHI were found when compared to baseline following 6 visits of physical therapy.

Discussion: The purpose of this case report was to analyze the effects of a vestibular rehabilitation program with inclusion of balance training, vestibular rehabilitation, and lower extremity strength training on improvement in dizziness and instability with walking. Results from tests and measures suggested vestibular hypofunction was the diagnosis present in this patient, not BPPV. Considerable improvement in Romberg test was observed along with improved results from the Head Impulse test, DHI & DGI outcome measure scores, and subjective decreased reports of dizziness. With the dizziness reportedly beginning a few weeks following radiation treatment in the cervical region for tonsil cancer, radiation damage to the vestibular system must be considered as a possible contributor to the onset of her symptoms. Physical therapy is not well understood for post-radiation damage to the vestibular system and warrants further research.

Faculty / Staff Sponsor

Dr. Roberta OShea

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Apr 12th, 4:00 PM Apr 12th, 6:00 PM

Differential Diagnosis of the Vestibular System and Effectiveness of a Vestibular Rehabilitation Program Following Radiation Treatment for Tonsil Cancer: A Retrospective Case Report

Background/purpose: Impairments in the vestibular system are a common diagnosis seen in physical therapy today. The most common vestibular diagnosis is Benign Positional Vertigo (BPPV) with vestibular hypofunction occurring second most common. Vestibular hypofunction usually results from neuritis, chronic inflammation of peripheral system, or infection. Previous studies examined the effectiveness of vestibular rehabilitation training on postural stability and gaze stabilization for individuals with bilateral or unilateral vestibular hypofunction but research is limited for vestibular rehabilitation training following radiation treatment. Therefore, the purpose of this retrospective case report is to document the impact of a vestibular rehabilitation program on improving vestibular hypofunction, resulting from neurotoxicity following radiation treatment.

Case Description: The subject was an 88 year old Caucasian female who had reported symptoms including: dizziness, lightheadedness, and “feeling off” when moving her head and changing positions, specifically from supine to sitting. The patient reported symptoms began approximately 3 weeks ago following the end of her last radiation treatment for palatine tonsil cancer in her neck.

Outcomes: The patient was seen by an SPT, supervised by a PT for a total of six visits. Improvements in both the DGI and DHI were found when compared to baseline following 6 visits of physical therapy.

Discussion: The purpose of this case report was to analyze the effects of a vestibular rehabilitation program with inclusion of balance training, vestibular rehabilitation, and lower extremity strength training on improvement in dizziness and instability with walking. Results from tests and measures suggested vestibular hypofunction was the diagnosis present in this patient, not BPPV. Considerable improvement in Romberg test was observed along with improved results from the Head Impulse test, DHI & DGI outcome measure scores, and subjective decreased reports of dizziness. With the dizziness reportedly beginning a few weeks following radiation treatment in the cervical region for tonsil cancer, radiation damage to the vestibular system must be considered as a possible contributor to the onset of her symptoms. Physical therapy is not well understood for post-radiation damage to the vestibular system and warrants further research.