Barriers to Vestibular Rehabilitation in Acoustic Neuroma Surgical Patients

In this retrospective review, we examined the rates of vestibular rehabilitation (VR) referral and completion after vestibular schwannoma (VS) resection and identify possible barriers toward attendance.

A total of 145 institutional VS patients underwent microsurgery for VS. A second cohort of 6,431 patients were identified in TriNetX by querying for the relevant ICD-10 and Current Procedural Terminology codes. We measured patient demographics and VR referral, along with zip code, insurance status, median household income, and distance to VR. VR utilization was recorded as not attended, attended, completed, or lost to follow-up.

The rate of referral for our patient population was 42.1%, of which 60.7% attended VR at least once and 36.1% completed with a formal discharge. Increased distance from a therapy site was associated with a lower likelihood of completing therapy (odds ratio, 0.91; 95% CI, 0.85-0.97). The attrition rate was 40.5%. Women (56.5%, p = 0.01), older patients (67.4%, p < 0.01), and those with increased distance (p = 0.004) had significantly higher attrition rates. The TriNetX cohort similarly showed that only 25.7% of patients attended at least one VR session postoperatively.

VR appears to be underutilized despite having benefits in improving patient quality of life. It is our opinion that postoperative referral to VR should be offered to all patients. Access to this specialized service appears to be most affected by the distance required to travel to these therapy sites. Further work into possible mitigation strategies is warranted to help this patient population.