Application of Virtual Reality in Patients with Peripheral Vestibular Dysfunction and Vertigo: A Scoping Review

Background: Peripheral vestibular dysfunction (PVD), including conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease, is a prevalent cause of vertigo and balance impairments among adults. These conditions significantly increase the risk of falls and reduce quality of life due to associated anxiety and physical limitations [1]. While traditional Vestibular Rehabilitation Therapy (VRT) is the standard of care, its effectiveness is often limited by poor patient adherence due to the repetitive and monotonous nature of the exercises [2].In recent years, Virtual Reality (VR) technology has emerged as a promising tool to enhance vestibular rehabilitation. By providing immersive, multi-sensory feedback and gamified elements, VR can potentially improve patient motivation and compliance [3]. Recent systematic reviews suggest that VR-based interventions may be as effective as, or even superior to, conventional VRT in improving dizziness and balance [4]. However, there is significant heterogeneity in the available literature regarding the types of VR utilized (immersive vs. non-immersive), intervention protocols, and safety profiles (e.g., cybersickness) [5]. A scoping review is therefore necessary to map the existing evidence and identify key characteristics of VR applications in this specific population. Objectives: The primary objective of this scoping review is to systematically map the extent, range, and nature of research activity regarding the use of VR in patients with peripheral vestibular dysfunction and vertigo. Specifically, this review aims to address the following questions: Intervention Characteristics: What are the types of VR (immersive vs. non-immersive), preparation procedures, specific intervention elements, and monitoring methods used in current practice? Application Effects: What are the reported outcomes regarding the effectiveness, safety (including adverse events like cybersickness), and feasibility of VR interventions? Methods: This review will be conducted in accordance with the JBI methodology for scoping reviews and reported using the PRISMA-ScR checklist. Eligibility Criteria (PCC Framework):Population: Adults (aged greater than or equal to18 years) diagnosed with peripheral vestibular dysfunction accompanied by vertigo. Concept: Interventions utilizing Immersive VR (IVR) or non-Immersive VR (nIVR). IVR is defined as systems using head-mounted displays (HMDs) to isolate users from the real environment, while nIVR involves screen-based interactions (e.g., computers, tablets).Context: Rehabilitation conducted in any setting, including hospitals, clinics, or home-based environments. Search Strategy: A comprehensive search will be conducted across 8 electronic databases: PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database (CBM), Wanfang Data, VIP Database, and CNKI. Data Analysis: Data will be extracted and charted to categorize intervention types, dosing parameters, and outcome measures. Results will be presented in tabular and diagrammatic formats accompanied by a narrative summary. Expected Outcomes: This review will provide a comprehensive overview of the current landscape of VR rehabilitation for peripheral vestibular dysfunction. By identifying gaps in current protocols—particularly regarding optimal dosing and safety monitoring—this study will provide evidence-based recommendations for future clinical trials and standardizing rehabilitation practice REFERENCES [1]Strupp M, Kern NL, Laurell G, Lehner L, Grill E, Strobl R. World-wide survey on the treatment of peripheral vestibular disorders. Front Neurol. 2025;16:1540443. Published 2025 Feb 4. doi:10.3389/fneur.2025.1540443 [2]Im YH, Lee HJ, Jeon EJ. Adherence to customized vestibular rehabilitation therapy: influencing factors and clinical implications in vestibulopathy. Front Neurol. 2025;16:1538989. Published 2025 Feb 5. doi:10.3389/fneur.2025.1538989 [3]Xie M, Zhou K, Patro N, et al. Virtual Reality for Vestibular Rehabilitation: A Systematic Review. Otol Neurotol. 2021;42(7):967-977. doi:10.1097/MAO.0000000000003155 [4]Liu X, Yang S, Wang Y, et al. Comparison of the effectiveness of immersive and non-immersive virtual reality in the treatment of vertigo in patients with peripheral vestibular dysfunction: a systematic review and meta-analysis. Front Neurol. 2025;16:1638868. Published 2025 Jul 17. doi:10.3389/fneur.2025.1638868 [5]Fernández-Cañas M, Ortiz-Gutiérrez RM, Martín-Casas P, et al. Cybersickness Evaluation in Immersive Virtual Environments: A Systematic Review with Implications for Neurological Rehabilitation. J Clin Med. 2025;15(1):46. Published 2025 Dec 21. doi:10.3390/jcm15010046