Inner ear (audio-vestibular mechanism) dysfunction may result in comorbidities of; hearing impairment, dizziness, vertigo, and imbalance. Many times, these symptoms are not mutually exclusive, and a myriad of symptoms arise from acute pathologies or trauma to the inner ear. This system is vulnerable across an individual's lifespan from infant to older adult. In this case study, we will examine a case of a 74-year-old male with bilateral vestibular dysfunction and subsequent history of falls and imbalance. His childhood history is of interest, as he was deafened by spinal meningitis in infancy, post-language acquisition. In July 2020, he presented to our clinic at the American Institute of Balance (AIB), in Largo, Florida, USA, for complaints of progressively worsened balance function since 2017. As is the AIB protocol, a multidisciplinary approach included comprehensive neurodiagnostic and physical therapy assessment. Neurodiagnostic test results indicated a bilateral vestibulopathy. He was subsequently treated by the vestibular-trained Physical Therapy team for four weeks with clinically significant improvements in his Dizziness Handicap Inventory and objective scores for postural stability. Despite the absence of fully intact vestibular function, post-treatment outcomes revealed significant improvement on standardized subjective and objective measurements. This supports the efficacy of providing balance retraining therapy to individuals with demonstrable and irreversible bilateral vestibular deficiencies as a valid means to reduce their falls risk and improve their quality of life for activities of daily living.

Following a motor vehicle accident, there is a cascade of mechanical, chemical, and psychological events that can occur. 1,2 Many times this arduous process of assess-referassess can be detrimental to the physical and mental rehabilitation following this traumatic event. Efficient, streamlined processes in place may reduce the overall healthcare burden following a motor vehicle accident (MVA). We present a case study of a 56-year-old male with complaints of vertigo, neck pain, and disequilibrium. Following emergency department clearance with imaging techniques and referral for further evaluation. The patient was seen five weeks following his injury at The American Institute of Balance (AIB). The AIB is a multidisciplinary clinic with specialists in vestibular Audiology and Physiotherapy with utilization of comprehensive neurodiagnostic and assessment protocols. A confirmed right ear, posterior canal Benign Paroxysmal Positional Vertigo(BPPV-PC) was successfully treated with the Gans Repositioning Maneuver (GRM). This was followed by physiotherapy interventions for his complaints of neck pain and imbalance, post clearance of the BPPV-PC. He was seen in the clinic for a total of three weeks, with a progression of home exercise given each week. At the end of his physiotherapy, he was discharged with no further complaints of vertigo and significantly improved mobility, strength, and subjective reports for his neck pain. This case study demonstrates the necessity for proper evaluation and comprehensive treatment when multiple comorbidities follow traumatic events. This ensures time-efficient management and successful and measurable treatment outcomes.