Short answer
After surgery or radiation for an acoustic neuroma (vestibular schwannoma), the balance nerve on that side is often lost or weakened, and vestibular rehabilitation helps the brain compensate, much as it does after vestibular neuritis1. Vestibular paroxysmia is different: very brief, frequent spells of vertigo, often linked to a blood vessel pressing on the balance nerve, and it is usually managed with medicine by a neurologist or ENT2.
Answered by Dr. Manan Patel, PT, DPT, TPS, Certified Vestibular Specialist and Therapeutic Pain Specialist. Updated October 18, 2026.
What does rehabilitation look like after acoustic neuroma surgery?
Expect dizziness and unsteadiness in the first days after surgery as the brain adjusts to losing input from one side. Once your surgeon clears you, therapy starts with gentle gaze stabilization and walking, then progresses to faster head movements, busier visual scenes and harder balance challenges. Some people also have facial weakness or hearing loss on the treated side, so we coordinate closely with the surgical team.
What is vestibular paroxysmia?
Vestibular paroxysmia causes attacks of spinning or unsteady dizziness that last from about a second to a few minutes and can happen many times a day, sometimes with ringing or a change in hearing2. It is thought to be caused by a blood vessel compressing the eighth cranial nerve. Improvement with a medicine such as carbamazepine or oxcarbazepine supports the diagnosis.
Where does physical therapy fit for vestibular paroxysmia?
Therapy does not stop the attacks, but it can help with the imbalance and movement avoidance that frequent spells leave behind. It also helps rule out look-alikes such as BPPV, which causes brief spells too, but only with position changes. Infrared video goggle testing helps tell these apart.
Do you see neuro-vestibular patients from Johns Creek, Cumming and Alpharetta?
Yes. Patients recovering from vestibular schwannoma treatment or living with other complex vestibular conditions come to our Cumming and Alpharetta clinics from Johns Creek, Milton, Roswell, Suwanee and Forsyth County. Visits are 60 minutes, one-on-one, and we send findings to your surgeon, neurologist or ENT.
Where can I get help in Alpharetta, Cumming and nearby?
Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.
Cumming clinic
Off GA-400 Exit 13 on Peachtree Parkway
Cumming, GA 30041
Alpharetta clinic
Inside Georgia Brain & Spine Physical Therapy
Alpharetta, GA 30022
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References
- Hall CD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline. Journal of Neurologic Physical Therapy. 2022.
- Strupp M, et al. Vestibular paroxysmia: Diagnostic criteria. Journal of Vestibular Research. 2016.
This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.
