By Millie Brecheisen, physiotherapist in Basel. Updated: 1 October 2026.
Ménière’s disease often involves very different phases. Attacks, hearing fluctuations and unsteadiness between episodes are not treated in the same way. Vestibular rehabilitation can help with some functional consequences, at a time agreed with the ENT specialist.
A fluctuating inner ear condition
Ménière’s disease typically combines spontaneous vertigo attacks with fluctuating hearing symptoms, such as hearing loss, tinnitus or a feeling of pressure in the ear. Diagnosis and treatment of the disease itself belong to ENT care. Vestibular physiotherapy does not claim to stop the hydrops or replace medical treatment.
Why rehabilitation differs during and between attacks
During a highly fluctuating phase, demanding vestibular exercises may be poorly tolerated because the peripheral signal changes from day to day. After repeated episodes, however, some people develop lasting vestibular hypofunction and unsteadiness between attacks. Rehabilitation becomes more relevant in this situation.
What recent research tells us
A 2023 systematic review and meta-analysis found short-term improvement in dizziness-related disability with vestibular rehabilitation. However, the studies had a high risk of bias, considerable heterogeneity and no long-term follow-up [1]. French recommendations published in 2026, first available online in late 2025, mainly suggest individualised rehabilitation for progressive, uncompensated vestibular deficits or after medical or surgical vestibular suppression [2].
What can physiotherapy address?
When the condition is stable, an assessment may identify unsteadiness, reduced gaze stability, visual dependence or walking difficulties. The programme can then include balance, head movements, gaze stabilisation and a return to activities.
Someone with Ménière’s disease can also develop BPPV, vestibular migraine or fear of movement. Persistent symptoms should therefore not automatically be attributed to Ménière’s disease.
When to contact your ENT specialist again
A hearing change, more frequent attacks, a new neurological symptom or a clear change in the pattern should prompt medical reassessment. The aim is to coordinate treatment of the disease with functional rehabilitation.
Clinical clues that guide the assessment
Useful clues include spontaneous attacks associated with fluctuating hearing symptoms. Hearing loss, tinnitus or ear fullness point towards ENT assessment. In physiotherapy, it is particularly important to document unsteadiness between attacks, remaining vestibular function and the stability of the condition before increasing exercise demands.
Agreeing on the right time with ENT care
Rehabilitation addresses the consequences of a deficit that has become sufficiently stable. It is not an automatic response to every new attack.
- Document fluctuations in dizziness and hearing alongside ENT follow-up.
- Identify persistent unsteadiness and check for an uncompensated vestibular deficit.
- Choose a supervised programme, then adjust its demands if the condition becomes fluctuating again.
Recent French recommendations suggest waiting for a three-month period of stability before this type of rehabilitation [2]. This guides treatment planning; sudden hearing loss requires prompt medical advice.
An individual assessment in Basel
In Basel, rehabilitation for unsteadiness related to Ménière’s disease is coordinated with ENT care. It mainly addresses persistent deficits during a sufficiently stable phase. Hearing reports, vestibular test results and the history of attacks help determine the appropriate timing and content of follow-up.
Frequently asked questions
Can physiotherapy prevent Ménière’s attacks?
That is not its main role. It mainly addresses vestibular deficits and persistent unsteadiness between attacks.
Should I exercise during a very unstable phase?
Exercise dosage needs caution and coordination with medical care. Recent recommendations favour a sufficiently stable period for effective rehabilitation.
Can Ménière’s disease and vestibular migraine look similar?
Yes, some symptoms overlap. Hearing symptoms, the history of attacks and medical assessment help distinguish them.
Related articles
- Dizziness and vestibular rehabilitation in Basel
- Vestibular migraine: dizziness with or without a headache
- Unilateral vestibular hypofunction: symptoms and rehabilitation
- Bilateral vestibulopathy: unsteadiness in the dark and bouncing vision
Scientific references
[1] The effect of vestibular rehabilitation in Meniere disease: systematic review and meta-analysis. 2023. Read the reference on PubMed.
[2] Dubernard X et al. Guidelines of the French Society of ENT (short version) on the role and modalities of vestibular rehabilitation in Menière’s disease. European Annals of Otorhinolaryngology, Head and Neck Diseases, 2026 (published online in 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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