Clinical application of the vestibular rehabilitation combined with heart rate variability biofeedback therapy for patients with chronic dizziness

Vestibular rehabilitation (VR) has been performed to improve the symptoms and function of patients with dizziness. However, autonomic symptoms such as nausea, sweating, shortness of breath, fatigue, flushing and anxiety during the rehabilitation process make it awkward for some patients to continue with rehabilitation. Anti-emetic or anti-anxiety drugs have been applied to dizzy patients to reduce the symptoms. However such drugs have been reported to delay vestibular compensation. Recently an approach involving heart rate variability biofeedback therapy (HRV-BF therapy) has been proved to be useful in cases of asthma, hypertension, anxiety disorder and post-traumatic stress disorder by strengthening autonomic function homeostasis including the vagal afferent pathway and baroreceptors. We therefore performed vestibular rehabilitation combined with HRV-BF therapy (VR with HRV-BF) in four dizzy patients with a unilateral vestibular disorder and with a high scores on the Dizziness Handicap Inventory (DHI) and Nijmegen Questionnaire for hyperventilation (NQH). VR with HRV-BF promptly reduced the subjective dizzy symptoms and improved the DHI and NQH scores. We believe that HRV-BF therapy may enhance the efficiency of VR for some patients with chronic dizziness.