Vestibular Rehabilitation for Chronic Dizziness: Diagnostic Tool Performance, Intervention Effectiveness, and Determinants Across Vestibular Disorders

Dizziness and vertigo are among the most common neurological and otological complaints in primary care and emergency settings, with substantial chronicity, falls risk, and quality-of-life impact. The clinical spectrum encompasses benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, persistent postural-perceptual dizziness (PPPD), vestibular migraine, bilateral vestibulopathy, and other less common conditions. Diagnostic accuracy is essential different conditions require different interventions, and central pathology requires exclusion. Vestibular rehabilitation therapy (VRT) provides structured exercise-based intervention addressing habituation, adaptation, and substitution mechanisms. We undertook a 12-week three-arm cohort study of 298 patients with chronic dizziness comparing individualised VRT (n=148), generic vestibular exercises (n=82), and no structured VRT (n=68). Video head impulse test (vHIT) demonstrated superior diagnostic performance for peripheral vestibular dysfunction (AUC 0.92) compared with HINTS exam (0.88), Dizziness Handicap Inventory (0.78), and history alone (0.66). Individualised VRT produced 76% symptom resolution at 12 weeks versus 52% generic and 24% no VRT. Strongest predictors of resolution included BPPV with successful repositioning, individualised VRT, recent symptom onset, acute peripheral aetiology, and home exercise engagement.