Vestibular rehabilitation for a patient with vestibular neuritis following coronavirus disease 2019: a case report

This case report highlights the rehabilitation process of a patient diagnosed with vestibular neuritis in temporal association with COVID-19 infection. The novelty lies in the use of the Zur Balance Approach for vestibular rehabilitation, which integrates personalized gaze and balance training, including manual therapy and biofeedback training using the Functional Head Impulse Test (fHIT). To date, few reports have described the rehabilitation process and follow-up outcomes of patients with vestibular neuritis occurring in temporal association with COVID-19. A 54-year-old woman of Middle Eastern Ethnicity presented to our clinic with complaints of persistent dizziness, imbalance, and oscillopsia, exacerbated by head movements. The symptoms began 3 weeks earlier with an acute attack of vertigo, nausea, and vomiting, which coincided with a positive COVID-19 test. Clinical assessments revealed unilateral vestibular hypofunction consistent with vestibular neuritis of the left labyrinth. The rehabilitation program combined the Zur Balance Approach, emphasizing a holistic and personalized approach to vestibular exercises, and fHIT biofeedback training to improve vestibulo-ocular reflex function. Over 6 months, the patient underwent 10 structured therapy sessions and performed home exercises. Significant improvements were observed in all functional and subjective measures, including balance confidence, postural stability, and vestibulo-ocular reflex gain. This case report describes clinical improvement following the Zur Balance Approach in a patient with vestibular neuritis occurring in temporal association with COVID-19. By integrating personalized, whole-body approaches with modern tools such as the fHIT, the patient experienced improved balance, reduced dizziness, and a return to daily function. These findings suggest that combining traditional vestibular rehabilitation techniques with biofeedback-based training may have potential utility for patients with unilateral vestibular hypofunction. Larger controlled studies are needed to evaluate the effectiveness of these interventions.