By Millie Brecheisen, physiotherapist in Basel. Updated: 1 October 2026.
The severe spinning attack has stopped. Sitting feels better, but turning your head, walking quickly or reading a sign while moving is still difficult. Unilateral vestibular hypofunction can leave this kind of discomfort even after vertigo at rest has settled.
Reduced function does not always mean constant vertigo
Unilateral vestibular hypofunction means that vestibular signals from one side are reduced. It may follow vestibular neuritis, surgery or certain inner ear conditions, although sometimes no clear cause is identified. Patients do not always describe spinning. Common long term difficulties include unsteadiness, dizziness, trouble keeping vision stable and discomfort during dynamic activities [1].
The vestibulo ocular reflex is central to the problem
When the head moves, the vestibulo ocular reflex (VOR) helps keep the image stable on the retina. If it works less effectively, reading a sign while walking or seeing clearly during quick head movements becomes harder. The brain may partly compensate through vestibular adaptation, eye movement strategies and visual and body sensory information.
Why symptoms sometimes persist
A 2023 review found that a meaningful proportion of patients remained moderately or more severely affected despite rehabilitation [1]. This does not mean exercises are useless. It highlights the need to look for contributing factors: a substantial vestibular deficit, migraine, visual dependence, fear of movement, proprioceptive difficulties, deconditioning or an unrecognised bilateral impairment.
What targeted rehabilitation looks like
Treatment may combine gaze stability exercises with head movements, balance, walking, direction changes and exposure to genuinely troublesome situations. A prospective study in 2023 found better outcomes when relevant components were combined rather than using a more limited programme [2].
The aim is not to mechanically repeat one exercise for months. Difficulty changes with speed, the base of support, available vision, visual surroundings and functional tasks. More specific VOR approaches are also being studied [3].
How to recognise progress
How you feel during one session is not the only measure. Follow up may consider dynamic visual acuity, balance, walking, head movement speed, avoided activities and disability questionnaires. For a sportsperson, progression should reach the demands of the sport, beyond the disappearance of vertigo at rest.
Clinical points that help make sense of the assessment
Useful findings may include an abnormal clinical head impulse test or vHIT, reduced dynamic visual acuity, unsteadiness with head movements and difficulty when visual information is less available. In rehabilitation, track the head speed actually tolerated and walking function, as well as repetitions.
Adapting the VOR: move the head while keeping a target clear
In a gaze stability exercise, the eyes stay on a target while the head moves. This detail matters. Tracking a moving target with the eyes while keeping the head still does not train the same mechanism.
- Choose a target and head speed consistent with image clarity and the assessment.
- Adjust duration, speed, posture and visual background separately.
- Then check reading signs, getting around and walking with head movements.
The appropriate exercise depends on remaining vestibular function. Strong symptom provocation is not proof of effectiveness. Substitution strategies may also have a place.
A physiotherapy assessment in Basel
Rehabilitation in Basel can follow gaze stability, walking and activities involving head movement. Available vHIT, caloric or other specialist test results are useful. The programme should match the observed deficit and develop as function improves.
Frequently asked questions
Can vestibular hypofunction recover?
Peripheral function may partly recover depending on the cause. The brain can also compensate effectively through adaptation and sensory substitution.
Why is it worse in the dark?
Vision contributes less to balance in darkness, making a vestibular deficit more apparent.
Should exercises provoke symptoms?
A small temporary increase may be part of training, but dosage should remain controlled and allow recovery.
Related articles
- Dizziness and vestibular rehabilitation in Basel
- Vestibular neuritis: understanding acute vertigo and recovery
- Bilateral vestibulopathy: unsteadiness in the dark and bouncing vision
- Oscillopsia: when your vision bounces as you walk
Scientific references
[1] Karabulut M et al. Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis. Front Neurol. 2023. Read the reference on PubMed.
[2] Lilios A et al. Different Vestibular Rehabilitation Modalities in Unilateral Vestibular Hypofunction: A Prospective Study. Otology & Neurotology, 2023. Read the reference on PubMed.
[3] González-García M et al. Efficacy of vestibular rehabilitation using unidirectional rotation paradigm in VOR asymmetry: systematic review and meta-analysis. 2025. Read the reference on PubMed.
This information explains possible mechanisms and rehabilitation options. Diagnosis and treatment depend on an individual assessment.
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