Neuro-otology · London
Vestibular rehabilitation therapy (VRT) - London.
Specialist physiotherapy and audiovestibular programmes for BPPV, vestibular neuritis, PPPD, post-concussion dizziness and Ménière's. Consultant-led assessment, Epley and Semont manoeuvres, gaze stabilisation, habituation and structured balance retraining.
What VRT is
Re-training the balance system, session by session.
Vestibular rehabilitation therapy is a supervised programme delivered by a specialist neuro-physiotherapist or audiovestibular scientist. It uses the brain's capacity to recalibrate the vestibulo-ocular reflex, to habituate to provocative movement, and to substitute vision and proprioception when the inner ear cannot compensate on its own. The result is fewer falls, less oscillopsia, and a life that no longer revolves around dizziness.
Who it helps
Indications for vestibular rehabilitation.
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BPPV
Benign paroxysmal positional vertigo - brief spinning triggered by head position, resolved with repositioning manoeuvres.
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Vestibular neuritis and labyrinthitis
Acute inflammatory loss of vestibular function - severe rotational vertigo, nausea, gait disturbance.
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PPPD
Persistent postural-perceptual dizziness - chronic non-vertiginous dizziness, worse standing, in busy visual environments, or with motion.
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Post-concussion dizziness
Vestibular and oculomotor symptoms after mild traumatic brain injury, often overlapping with cervicogenic dizziness.
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Ménière's disease
Rehabilitation between attacks to reduce inter-episode imbalance and improve gaze stability.
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Bilateral vestibular loss
Oscillopsia and unsteadiness from gentamicin toxicity or idiopathic loss - substitution and balance retraining.
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Chronic dizziness and unsteadiness
Persistent symptoms after an inconclusive workup, or in older adults with multifactorial imbalance.
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Visual vertigo
Symptoms provoked by supermarkets, crowds, driving or screens - habituation and desensitisation.
Assessment
A proper diagnosis before any exercise.
Every VRT programme starts with a 60 to 90 minute assessment. That includes a full oculomotor examination, the HINTS battery where an acute vestibular syndrome is suspected, Dix-Hallpike and supine roll tests for BPPV, the head impulse test for VOR gain, dynamic visual acuity, and standardised balance measures such as the Berg Balance Scale or Functional Gait Assessment. Where the picture is unclear, we refer for videonystagmography, vHIT and audiometry with an audiovestibular consultant before treatment continues.
Techniques
What actually happens in a session.
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Canalith repositioning
Epley and Semont manoeuvres for posterior canal BPPV; Gufoni and BBQ roll for horizontal canal. Brandt-Daroff exercises for self-treatment.
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Gaze stabilisation
VOR x1 and VOR x2 exercises to recalibrate the vestibulo-ocular reflex - staged by speed, distance and background complexity.
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Habituation
Motion-Sensitivity Quotient guided exposures - repeated brief provocation of symptoms to reduce central sensitivity.
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Balance retraining
Progressive standing and gait tasks on firm and compliant surfaces, eyes open and closed, with head turns and dual tasks.
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CBT and pacing for PPPD
Cognitive-behavioural work, graded exposure and vestibular physiotherapy - the combination outperforms either alone.
Programme
Eight to twelve weekly sessions, plus daily home work.
A typical programme runs eight to twelve weekly clinic sessions over two to three months, supported by a prescribed daily home routine of gaze stabilisation, habituation and balance exercises. BPPV usually resolves in one to three sessions once the affected canal is identified. Post-concussion and PPPD programmes are longer and combine vestibular work with graded exposure, pacing and, where appropriate, cognitive-behavioural therapy. Progress is measured with the Dizziness Handicap Inventory and repeat gait and balance tests.
Cost in London
What private VRT costs.
| Item | Indicative price |
|---|---|
| Initial assessment (60-90 min) | £180-£280 |
| Follow-up session (45-60 min) | £120-£220 |
| Epley/Semont session for BPPV | £150-£250 |
| 8-12 session VRT programme | £1,200-£2,400 |
| Audiovestibular consultant review | £300-£500 |
Prices vary by clinic, seniority and whether an audiovestibular consultant is involved. We confirm firm figures with your matched clinic before you book.
Where in London
Vetted VRT providers.
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National Hospital for Neurology, Queen Square (Private Patients)
Tertiary neuro-otology, complex PPPD and bilateral vestibular loss.
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HCA Wellington Hospital Neuro
Consultant-led neuro-physiotherapy and neurology in St John's Wood.
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Cromwell Hospital (Bupa)
Physiotherapy and ENT/audiovestibular services in Kensington.
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London Vestibular Clinic
Independent specialist VRT clinic in Marylebone.
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ACPIN neuro-physiotherapists
Vetted independent chartered physiotherapists across Greater London.
Frequently asked
FAQs on private VRT.
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What is vestibular rehabilitation therapy?
VRT is a specialist physiotherapy or audiovestibular programme that re-trains the balance system after vestibular injury or in chronic dizziness. It uses canalith repositioning for BPPV, gaze stabilisation for VOR loss, habituation for motion sensitivity, balance retraining, and cognitive-behavioural strategies for PPPD.
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How is the assessment done?
A 60-90 minute assessment covers history, oculomotor examination (smooth pursuit, saccades, gaze-evoked nystagmus), the HINTS battery where an acute vestibular syndrome is suspected, Dix-Hallpike and supine roll test for BPPV, head impulse test for VOR gain, dynamic visual acuity, and standardised balance and gait measures.
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How many sessions will I need?
BPPV often resolves in one to three sessions with a repositioning manoeuvre plus home exercises. A full programme for vestibular neuritis, PPPD or post-concussion dizziness typically runs eight to twelve weekly sessions, with a daily home programme of gaze stabilisation, habituation and balance work.
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How much does private VRT cost in London?
Expect £120-£220 per session with a specialist neuro-physiotherapist, and £180-£280 for the initial assessment. An eight to twelve session programme is typically £1,200-£2,400. Consultant audiovestibular review is £300-£500 where the diagnosis is unclear.
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Is VRT covered by private medical insurance?
Most policies cover VRT when referred by a GP or consultant with a clear vestibular diagnosis. Bupa, AXA Health, Vitality, Aviva and WPA usually authorise a defined number of sessions. Pre-authorisation is required and we check cover before you book.
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Does VRT work for PPPD?
Yes. The strongest evidence in PPPD is for combined vestibular physiotherapy, cognitive-behavioural therapy and, where indicated, an SSRI or SNRI. Around 60-80% of patients report meaningful improvement over three to six months. Isolated exercises without the cognitive component are less effective.
Related
Related conditions and treatments.
Ready to start
Match with a London vestibular specialist this week.
Send a short summary of your symptoms. We come back within one working day with two or three consultant-led options, indicative pricing and a written pathway.