RAPID FUNCTIONAL RECOVERY FOLLOWING MULTIMODAL VESTIBULAR PHYSIOTHERAPY IN A PATIENT WITH CHRONIC POSITIONALLY PROVOKED DIZZINESS WITHOUT OBSERVABLE POSITIONAL NYSTAGMUS: A CASE REPORT

Abstract

Background: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder characterized by positional vertigo or dizziness with characteristic positional nystagmus. Some patients, however, report reproduction of their characteristic symptoms during positional testing without observable nystagmus, creating diagnostic uncertainty and requiring careful clinical reasoning.

Case Presentation: A 37-year-old male information technology professional presented with a 2-year history of recurrent reeling sensations provoked by head movement and positional change, most pronounced during left-sided head movements and while checking blind spots when driving. Bilateral Dix–Hallpike testing reproduced his characteristic dizziness, more prominently on the left, without observable positional nystagmus; the supine roll test was negative. The presentation was interpreted as chronic positionally provoked vestibular dizziness clinically compatible with a subjective BPPV-like pattern, with BPPV retained as a working rather than confirmed diagnosis.

Intervention

The patient completed a five-day multimodal vestibular physiotherapy program comprising patient education, clinically directed canalith repositioning, Brandt–Daroff habituation exercises, VOR×1 gaze stabilization, progressive balance training, head-movement retraining, walking with head movements, functional movement retraining, and a structured home exercise program.

Outcome: Progressive improvement was observed throughout treatment. By Day 5 the patient reported resolution of dizziness during previously provocative activities, including looking downward, bilateral head turning, and checking blind spots while driving, and resumed driving and occupational activities without the previously experienced reeling sensation. The Dizziness Handicap Inventory (DHI) score improved from 8/100 at baseline to 0/100 on Day 5, and repeat clinical assessment did not reproduce his previously reported symptoms.

Conclusion: This case illustrates rapid short-term functional improvement following multimodal vestibular physiotherapy in a patient with chronic positionally provoked dizziness and symptom reproduction on Dix–Hallpike testing without observable nystagmus. It underscores the value of comprehensive vestibular and functional assessment and cautious diagnostic interpretation when positional symptoms occur in the absence of objective nystagmus. As a single case involving multiple simultaneous interventions and no control condition, treatment efficacy and the independent contribution of individual components cannot be established.