Effect of Auditory Exercises on postural control and co-ordination among individuals with Benign Paroxysmal Positional Vertigo:- A case series

Effect of Auditory Exercises on postural control and co-ordination among individuals with Benign Paroxysmal Positional Vertigo:- A case series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Effect of Auditory Exercises on postural control and co-ordination among individuals with Benign Paroxysmal Positional Vertigo:- A case series Abhay Sharma, Nidhi Sharma, Mandeep Kumar Jangra, Akanksha Saxena This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8761555/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Benign Paroxysmal Positional Vertigo (BPPV) is characterized by brief episodes of vertigo triggered by head movements and is commonly associated with impairments in postural control and coordination. Although canalith repositioning maneuvers(CRM) are the primary treatment, residual balance deficits may persist, highlighting the need for adjunct rehabilitation strategies. Auditory-based exercises may facilitate multi-sensoryintegration and enhance balance control; however, evidence supporting their role in BPPV rehabilitation remains limited. This case series aimed to estimate the impact of a structured auditory exercise program on postural control and coordination in individuals with BPPV. Case presentation Five individuals aged 20–50 years diagnosed withright or left posterior canal BPPV were included in this case series. All participants initially underwent standard canalith repositioning maneuvers (CRM), followed by a four-week auditory training program consisting of auditory attention tasks, spatial sound localization exercises, and dual-task auditory–motor coordination activities (30 minutes per day, five days per week). Outcome measures assessed pre- and post-intervention included the Mini-Balance Evaluation Systems Test (Mini-BESTest) for dynamic postural control, the Visual Vertigo Analogue Scale (VVAS) for visual-induced dizziness, the Dizziness Handicap Inventory (DHI) for dizziness-related functional limitations, and the Tandem Gait Test for gait coordination. Post-intervention assessments demonstrated consistent improvements across all outcomes. Mean Mini-BESTest scores increased from 15.8 (median 16) to 21.4 (median 20), VVAS scores decreased from mean 74.4 (median 73) to 61 (median 61), DHI scores decreased from mean 56.8 (median 54) to 31.6 (median 30), and tandem gait steps increased from mean 6.8 (median 6) to 11.4 (median 11). Conclusion This case series indicates that auditory-based exercises, when combined with standard canalith repositioning maneuvers, may positively influence postural control, reduce dizziness-related symptoms, and improve gait coordination in individuals with BPPV. These findings suggest a potential role for auditory exercises as a complementary intervention within vestibular rehabilitation programs aimed at enhancing balance and coordination outcomes in this population. Benign Paroxysmal Positional Vertigo Dizziness Postural Balance Gait Sound Localization Figures Figure 1 Introduction Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular condition defined by brief, position-induced episodes of vertigo with different nystagmus patterns that last less than a minute and are caused by changes in head position [1,2]. It is the leading cause of peripheral vertigo, accounting for at least 20% of cases in clinical practice [3]. Recent research suggests that sensory integration and balance deficits in BPPV patients may persist even after successful canalith repositioning procedures, especially under difficult sensory situations and in the medio-lateral and vestibular-dominant domains [4]. Despite clinical relief, studies show that mechanical repositioning may not fully restore functional stability in posterior canal BPPV patients. Postural control and coordination require the integration of vestibular, visual, somatosensory, and auditory signals to maintain equilibrium and movement. The auditory system offers critical spatial and temporal cues that affect balance, gait regularity, and movement timing, particularly in demanding circumstances [5,6]. These findings indicate a close relationship between auditory processing and motor control, and they support the use of systematic auditory workouts to improve sensory integration and coordination in vestibular diseases, including BPPV [7]. Auditory rehabilitation may include sound localization, spatial discrimination, rhythmic cueing, and dual-task activities, all of which have been shown in neurological diseases to improve gait and coordination [6,7]. When paired with vestibular and balance training, auditory exercises can improve postural corrections and functional coordination. Clinical procedures for BPPV frequently include vestibular and auditory exercises to enhance postural control and coordination via supervised balance and gait tasks with rhythmic auditory cues and changing sensory circumstances [8]. Although preliminary evidence suggests that including auditory components may improve balance and functional mobility when compared to vestibular training alone, results are limited and varied, and the specific benefits of auditory exercises are frequently unclear [9]. People with BPPV typically express instability in complex sensory contexts, indicating that auditory-focused training may have functional benefits for lowering fall risk and improving mobility [7]. However, because to a lack of high-quality evidence, the independent function of auditory activities in BPPV rehabilitation is not well established [8]. Considering this context, there is a need to evaluate the efficacy of auditory exercises on postural control and coordination in individuals with BPPV, both as an independent sensory intervention and as an adjunct to established vestibular rehabilitation approaches. Assessing the impact of structured auditory training on balance, gait coordination, and functional confidence may strengthen evidence-based rehabilitation strategies for this prevalent disorder [8]. By focusing on the auditory contribution to multi-sensory postural control, such research may support more comprehensive BPPV management and the development of personalized programs to enhance safety, participation, and quality of life [9]. Materials and Method The study was conducted in accordance with the guidelines of the Declaration of Helsinki (2013) [10] (World Medical Association, 2013) and the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants provided by the Indian Council of Medical Research (2017) [11]. Eligibility Criteria Inclusion criteria: • Adults ages 20 to 50 years • Participants willing to participate • Diagnosed with BPPV • Both male and female gender • Mini-BESTest 2 Exlusion criteria: • History of neurological disorders. • Patients with secondary BPPV • Cerebrovascular disease • Systemic illness • Refusal to participate in the study • Conditions contraindicating physical therapy • Severe cognitive impairment. Methodology Study Design A case series with five subjects Outcome measures Mini BESTest Visual Vertigo Analogue Scale (VVAS) DHI (Dizziness Handicap Inventory) Tandem Gait Test (Heel-to-Toe Walking) Outcome measures will be evaluated at baseline and post intervention. Intervention Protocol : Auditory Exercises Total duration: 5 days a week for 4 weeks Auditory Attention Exercises: - 1. Auditory Word Recall:- Procedure : Say a list of 5–7 unrelated words aloud (e.g., "dog, pen, ball, chair, moon") [12]. Ask the patient to repeat the words in any order [13] . Increase difficulty: Add more words, Introduce background noise, Ask for recall after a delay [14]. 2. Sound Matching / Sound Discrimination: Procedure: Play or produce two short sounds (i.e., hand clap vs. book tap), and ask the patient, “Are these the same or different?” – used to assess basic auditory discrimination [15,16]. Increase difficulty by using more similar sounds (e.g., different pitch, loudness) to enhance phonemic awareness [17]. Use minimal pairs (e.g., “bat” vs. “pat”) and ask the patient to identify or repeat the word heard – a common method in speech-language therapy [18]. Progress by incorporating pictures, delayed recall, or background noise depending on the individual’s level [15,17]. 3. Auditory Odd-One-Out: Procedure : Say a list of 4–5 spoken words (e.g., “dog, cat, apple, horse”) and ask the listener to identify the word that doesn’t belong and explain why – this targets semantic categorization and reasoning [19]. Use non-verbal auditory stimuli (e.g., 3 claps and 1 whistle) to train pattern recognition and sound discrimination [20]. Dual-Task Training: - Dual-Task Training involves performing auditory tasks alongside another task (e.g., physical or cognitive) to enhance multitasking abilities. 1. Walking + Cognitive Task (e.g., Counting Backward) : Procedure: Ask the patient to walk at a comfortable pace over a 10 m walkway. While walking, have them count backward aloud (i.e., from 10 to 1); this “walking while talking” paradigm is widely used to assess cognitive–motor interference [21,22]. Monitor gait speed, balance, and counting accuracy , focusing on dual-task costs—slower speed or more counting errors indicate greater interference [21,23]. 2. Tandem Walking + Spell Words : Procedure: Ask the pa tient to walk heel-to-toe (tandem gait) along a straight 3–10 m line, reducing their base of support. Ask them to spell simple words aloud (e.g., “train” or “table”), forwards or backwards to increase cognitive load. Observe and record changes in gait stability (wobbling, missteps), walking speed, and spelling performance, dual-task decrements indicate cognitive–motor interference [24,25]. Patients Information Among the five patients, there were five females only, mean age of years. All five patients had a confirmed diagnosis of BPPV from an ENT specialist and were subsequently referred to the physiotherapy department for therapeutic interventions. Case Description Case 1 A 24-year-old female student (BMI 21.5) with a 3-month history of recurrent positional vertigo was diagnosed with right posterior canal BPPV using the Dix–Hallpike Test. She reported balance difficulty during quick turns and moderate motion sensitivity in visually complex environments. Baseline assessment revealed impaired dynamic balance (Mini-BESTest 15/28), increased visual dependence (VVAS 58/100), moderate dizziness handicap (DHI 44/100), and poor tandem gait performance (5 steps in 25 seconds). After a 4-week program combining standard repositioning maneuvers with auditory exercises (auditory word recall, sound matching/discrimination, and dual-task training such as tandem walking with spelling), she showed marked improvement, with Mini-BESTest increasing to 23/28, VVAS reducing to 45/100, DHI to 22/100, and tandem gait improving to 12 consecutive steps in 24 seconds,along with subjectively reduced dizziness during daily activities. Case 2 A 24-year-old female student with BMI 16 experienced episodes of vertigo for 6 weeks, worsening during driving and during transitions from sitting to standing. She had left posterior canal BPPV confirmed by Dix–Hallpike Test. Baseline values included Mini-BESTest 1 6/28 , VVAS 72/100 , DHI 68/100 , and Tandem Gait of 11 steps (30 seconds) before instability. The patient underwent the same auditory training protocol emphasizing Auditory Word Recall , Sound Matching / Sound Discrimination , Dual-Task Training i.e. Tandem Walking + Spell Word . After 4 weeks, her postural control and confidence improved significantly. Post-therapy results showed Mini-BESTest 2 4/28 , VVAS 58/100 , DHI 2 6/100 , and Tandem Gait of 1 6 steps (23 seconds) . She reported better mobility in crowded environments and reduced sensitivity to visual motion. Case 3 A 50-year-old female housewife with BMI 26.1 had intermittent vertigo for over 2 months, triggered by rolling in bed and stair descent, diagnosed with right posterior canal BPPV, confirmed by Dix–Hallpike Test. Baseline assessment revealed mild balance impairment with a Mini-BESTest score of 1 7/28 , high visual motion sensitivity ( VVAS 73/100 ), and a DHI score of 52/100 . Her Tandem Gait Test showed 7 steps (27 seconds) before deviating from the line. She completed the 4-week auditory exercise intervention focusing on Auditory Word Recall , Sound Matching / Sound Discrimination , Dual-Task Training i.e. Tandem Walking + Spell Word . After completion, she demonstrated improved sensory re-weighting and movement control: Mini-BESTest increased to 2 0/28 , VVAS decreased to 62/100 , DHI dropped to 50/100 , and Tandem Gait improved to 11 (23 seconds) heel-to-toe steps . She reported improved stability during stair descent and reduced dizziness when lying to sitting. Case 4 A 37-year-old female teacher with BMI 22.7 presented with severe vertigo episodes for 1 month, particularly during head extension and rising from bed and diagnosed with right posterior canal BPPV confirmed by Dix–Hallpike Test. She exhibited poor gait stability and fear of falling. Baseline findings included Mini-BESTest 1 6/28 , VVAS 79/100 , DHI 54/100 (severe handicap) , and Tandem Gait of only 6 steps (26 seconds) before losing balance. After participating in the auditory exercise program, that mainly includes the Auditory Word Recall , Sound Matching / Sound Discrimination , Dual-Task Training i.e. Tandem Walking + Spell Word , significant improvements were noted at 4 weeks. Post-intervention results were Mini-BESTest 20/28 , VVAS 61/100 , DHI 30/100 , and Tandem Gait increased to 8 steps (23 seconds) . She described increased confidence in walking independently and reduced dizziness during head turns. Case 5 A 50-year-old female homemaker with BMI 27.2 complained of episodic vertigo for 4 months, aggravated while changing any position and walking in visually stimulating environments and had left posterior canal BPPV confirmed by Dix–Hallpike Test. Initial assessments indicated moderate balance deficits: Mini-BESTest 1 5/28 , VVAS 90/100 , DHI 66/100 , and Tandem Gait of 7 steps (30 seconds) . She underwent the 4-week intervention consisting of Auditory Word Recall , Sound Matching / Sound Discrimination , Dual-Task Training i.e. Tandem Walking + Spell Word . At the end of treatment, she demonstrated notable functional gains. Her Mini-BESTest improved to 2 0/28 , VVAS reduced to 79/100 , DHI decreased to 30/100 , and Tandem Gait improved to 10 steps (27 seconds) . She reported better tolerance in visually busy environments and minimal dizziness during household tasks. Diagnostic assessment All patients were assessed using outcome measures; Mini BESTest, Visual Vertigo Analogue Scale (VVAS), DHI (Dizziness Handicap Inventory), Tandem Gait Test (Heel-to-Toe Walking). Pre Assessment was conducted on the first day of patient’s presentation. Physiotherapy treatment was administered from the first day and continued for 1 week with sessions held for continuous days. Post assessment was conducted at the end of the last week from the start of the treatment. Mini BESTest The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a shorter version of the original BESTest, designed to assess dynamic balance and identify balance deficits across multiple systems. It consists of 14 tasks grouped into four domains: anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. These tasks evaluate different aspects of balance, such as standing on one leg, compensatory stepping, and walking with head turns. Each task is scored on a 3-point scale (0-2), with a maximum score of 28, where higher scores indicate better balance performance. The Mini-BESTest is widely used in clinical and research settings to assess balance in individuals with conditions such as Parkinson’s disease, stroke, and vestibular disorders. This test has the Excellent test-retest reliability ICC = 0.96 (0.94- 0.99) [26]. Visual Vertigo Analogue Scale (VVAS):- VVAS, as a quick method of quantifying VV and monitoring its response to treatment. It consists of a battery of analogue scales to rate the intensity of VV in 9 challenging situations of visual motions that typically provoke dizziness. These 9 items are based on yes-no questions given by Longridge and Mallinson [27] to identify visual vertigo. In the VVAS, the severity of symptoms is graded by analogue scales; therefore, the VVAS is a continuous scale. In a study comparing the VVAS score between vestibulopathic (n = 102) and control subjects (n = 101), we have reported that the VVAS is internally consistent and reliable (Cronbach α index = 0.94) [28]. DHI (Dizziness Handicap Inventory):- The Dizziness Handicap Inventory (DHI) is a widely used self-assessment questionnaire designed to evaluate the impact of dizziness on an individual's daily life, particularly focusing on functional, emotional, and physical aspects. It consists of 25 questions that help assess how dizziness affects activities such as walking, social interaction, and concentration, along with the emotional distress it may cause. The DHI provides a total score that reflects the severity of the handicap, with higher scores indicating greater impairment. ` These results suggest that the Dizziness Handicap Inventory is a reliable, valid, and responsive instrument for the assessment of perceived disability due to dizziness.The test-retest reliability coefficient was 0.97 [29]. Tandem Gait Test (Heel-to-Toe Walking):- The Tandem Gait Test, also known as the Heel-to-Toe Walking Test, is a simple clinical assessment used to evaluate balance, coordination, and postural control. During the test, the individual is instructed to walk in a straight line, placing the heel of one foot directly in front of the toes of the other, as if walking on a tightrope. This test challenges the body's ability to maintain balance by narrowing the base of support, making it more difficult to stabilize. It is often used to assess neurological function, vestibular disorders, and gait abnormalities. Difficulty completing the tandem gait may indicate issues with balance, coordination, or motor control. Heel-to-toe (ICC = 0.99, Cronbach's α – 0.994), lateral (ICC = 0.96, Cronbach's α – 0.988), and step-over walking (ICC = 0.96, Cronbach's α – 0.987) demonstrated excellent intra-rater reliability [30]. Results The normality of the data collected from all participants was verified using SPSS software. Due to the limited number or patients, the Shapiro-Wilk test was used, and the findings showed that the data were normally distributed (p > 0.05). Because the normality condition was met and the data showed statistical significance, parametric analysis was done. A paired t-test was performed to compare pre- and post-intervention results. The intervention resulted to significant improvements in all assessed outcome variables (p < 0.05), according to the paired t-test (Table 2, Figure 1). Table 1: The pre and post difference shows significantly improvement. Outcome Measures Mean±Standard Deviation T value P value Mini BESTest_Pre 15.80±0.83 -5.439 0.006 Mini BESTest_Post 21.40±1.94 VVAS_Pre 74.40±11.63 10.40 <0.001 VVAS_Post 61.0±12.14 DHI_Pre 56.80±10.05 3.65 0.022 DHI_Post 31.600±10.80 Tandem gait test_Pre 27.60±2.30 3.67 0.021 Tandem gait test_Post 24.00±1.73 The graph shows a consistent improvement across all five cases following the intervention. Post-intervention scores increased for the Mini-BESTest and Tandem Gait Test, indicating better balance and gait performance, while VVAS and DHI scores decreased, reflecting reduced vertigo severity and dizziness-related disability. Overall, the findings suggest that the intervention was effective in improving balance, functional mobility, and reducing symptoms associated with vestibular dysfunction. Discussion BPPV is the primary cause of peripheral vertigo (20-30% of patients), often results in sensory integration problems despite Canalith Repositioning Maneuvers (CRM) effectiveness, with deficiencies in mediolateral stability and dual- task performance that persist. Auditory signals provide spatial- temporal input, affecting sway and gait through multisensory pathways. Rhythmic music improves motor coordination in vestibular- impaired people, similar to parkinsons’s cueing effects. Nonverbal pattern recognition (e.g., claps/whistles) and word recall exercises improve auditory- motor interaction and reduced visual dependency, as seen by VVAS/DHI decreases [31]. This case series demonstrates that a 4-week auditory training program including sound localization, discrimination, and dual-task training activities such as tandem walking with word pronunciation significantly enhances postural control and coordination in posterior canal BPPV patients following Canalith Repositioning Maneuvers (CRM). Mini-BESTest scores increased from 15.8 to 21.4 (p=0.006), VVAS decreased from 74.4 to 61 (p=0.001), DHI from 56.8 to 31.6 (p=0.022), and tandem gait improved (p=0.021). These improvements demonstrate auditory training’s ability to correct residual deficits. Supporting evidence shows auditory exercises affect posture:- rotating sounds destabilize bilateral vestibulopathy/cochlear implant patients (increased center of pressure (COP) sway) but stabilize unilateral cases, indicating binaural cues role in balance when vestibular input fails. Vestibular rehabilitation post BPPV enhances Canalith Repositioning Maneuvers (CRM) by enhancing DHI stability, but it rarely isolates auditory components [9]. A protocol for vestibular- auditory combinations predicts superior Mini-BESTest gains, which are consistent with this case series. Unlike Brandt Daroff’s (repositioning focused) exercises, these ones focused on ecological skills for crowded environments [31]. In this five-patient case series, all participants showed improvement in balance, gait stability, and dizziness following the intervention. Reduced visual motion sensitivity, better sensory reweighting, increased confidence, and improved tolerance to visually complex environments were consistently observed, supporting the potential value of auditory exercises as an adjunct to vestibular rehabilitation in BPPV. Clinically, auditory exercises are effective adjuncts that promote independence and fall prevention. Personalized approaches could improve BPPV rehabilitation by developing auditory-vestibular coordination for overall recovery. Conclusion According to this case series, auditory exercises may improve postural control and coordination in individuals with benign paroxysmal positional vertigo. Improvements were seen in all participants after individualized auditory-based therapies were applied, suggesting that auditory input may play an essential role in improving motor responses that affect balance. These results indicate that auditory stimuli could be useful in promoting brain mechanisms related to balance control and multisensory integration. Therefore, combining auditory exercises to vestibular rehabilitation therapies may help control postural instability and coordination impairments related to BPPV more effectively, suggesting its application as a therapeutically meaningful and supportive intervention method. Abbreviations Abbreviations Full form BPPV Benign Paroxysmal Positional Vertigo CRM Canalith Repositioning Maneuvers VVAS Visual Vertigo Analogue Scale DHI Dizziness Handicap Inventory IEC Institutional Ethics Committee ENT Ear, Nose and Throat BMI Body mass index ICC Intraclass Correlation Coefficient COP Center of Pressure Dr. Doctor Declarations Follow-up and outcomes All the participants completed the four-week auditory exercise program and demonstrated improvements in postural control, balance, and coordination on post-intervention assessment. The intervention was well tolerated, with no adverse events reported. Ethics approval :- The study was approved from the Institutional Research Ethics Committee (IEC-3087) of a tertiary care teaching hospital. C onsent to participate :- Written consent was taken from all of the participants included in the study Funding :- None declared References Yetiser S (2020) Review of the pathology underlying benign paroxysmal positional vertigo. 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J Vestib Res 21:153–161 Karapolat H, Eyigor S, Kirazlı Y, Celebisoy N, Bilgen C, Kirazli T (2009) Reliability, validity and sensitivity to change of Turkish Dizziness Handicap Inventory in patients with unilateral peripheral vestibular disease. J Int Adv Otol 5 Koyama S, Tanabe S, Itoh N et al (2018) Intra- and inter-rater reliability and validity of the tandem gait test for the assessment of dynamic gait balance. Eur J Physiother 20:135–140 Guigou C, Toupet M, Delemps B, Heuschen S, Aho S, Bozorg Grayeli A (2018) Effect of rotating auditory scene on postural control in normal subjects, patients with bilateral vestibulopathy, unilateral, or bilateral cochlear implants. Front Neurol 9:972. doi:10.3389/fneur.2018.00972 Additional Declarations No competing interests reported. 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It is the leading cause of peripheral vertigo, accounting for at least 20% of cases in clinical practice [3]. Recent research suggests that sensory integration and balance deficits in BPPV patients may persist even after successful canalith repositioning procedures, especially under difficult sensory situations and in the medio-lateral and vestibular-dominant domains [4]. Despite clinical relief, studies show that mechanical repositioning may not fully restore functional stability in posterior canal BPPV patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostural control and coordination require the integration of vestibular, visual, somatosensory, and auditory signals to maintain equilibrium and movement. The auditory system offers critical spatial and temporal cues that affect balance, gait regularity, and movement timing, particularly in demanding circumstances [5,6]. These findings indicate a close relationship between auditory processing and motor control, and they support the use of systematic auditory workouts to improve sensory integration and coordination in vestibular diseases, including BPPV [7]. Auditory rehabilitation may include sound localization, spatial discrimination, rhythmic cueing, and dual-task activities, all of which have been shown in neurological diseases to improve gait and coordination [6,7]. When paired with vestibular and balance training, auditory exercises can improve postural corrections and functional coordination.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eClinical procedures for BPPV frequently include vestibular and auditory exercises to enhance postural control and coordination via supervised balance and gait tasks with rhythmic auditory cues and changing sensory circumstances [8]. Although preliminary evidence suggests that including auditory components may improve balance and functional mobility when compared to vestibular training alone, results are limited and varied, and the specific benefits of auditory exercises are frequently unclear [9]. People with BPPV typically express instability in complex sensory contexts, indicating that auditory-focused training may have functional benefits for lowering fall risk and improving mobility [7]. However, because to a lack of high-quality evidence, the independent function of auditory activities in BPPV rehabilitation is not well established [8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering this context, there is a need to evaluate the efficacy of auditory exercises on postural control and coordination in individuals with BPPV, both as an independent sensory intervention and as an adjunct to established vestibular rehabilitation approaches. Assessing the impact of structured auditory training on balance, gait coordination, and functional confidence may strengthen evidence-based rehabilitation strategies for this prevalent disorder [8]. By focusing on the auditory contribution to multi-sensory postural control, such research may support more comprehensive BPPV management and the development of personalized programs to enhance safety, participation, and quality of life [9].\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003eThe study was conducted in accordance with the guidelines of the Declaration of Helsinki (2013) [10] (World Medical Association, 2013) and the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants provided by the Indian Council of Medical Research (2017) [11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; Adults ages 20 to 50 years\u003c/p\u003e\n\u003cp\u003e\u0026bull; Participants willing to participate\u003c/p\u003e\n\u003cp\u003e\u0026bull; Diagnosed with BPPV\u003c/p\u003e\n\u003cp\u003e\u0026bull; Both male and female gender\u003c/p\u003e\n\u003cp\u003e\u0026bull; Mini-BESTest \u0026lt;22\u003c/p\u003e\n\u003cp\u003e\u0026bull; Visual Vertigo Analog Scale (VVAS) \u0026gt;2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExlusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; History of neurological disorders.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Patients with secondary BPPV\u003c/p\u003e\n\u003cp\u003e\u0026bull; Cerebrovascular disease\u003c/p\u003e\n\u003cp\u003e\u0026bull; Systemic illness\u003c/p\u003e\n\u003cp\u003e\u0026bull; Refusal to participate in the study\u003c/p\u003e\n\u003cp\u003e\u0026bull; Conditions contraindicating physical therapy\u003c/p\u003e\n\u003cp\u003e\u0026bull; Severe cognitive impairment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA case series with five subjects\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eMini BESTest\u003c/li\u003e\n \u003cli\u003eVisual Vertigo Analogue Scale (VVAS)\u003c/li\u003e\n \u003cli\u003eDHI (Dizziness Handicap Inventory)\u003c/li\u003e\n \u003cli\u003eTandem Gait Test (Heel-to-Toe Walking)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eOutcome measures will be evaluated at baseline and post intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention Protocol :\u0026nbsp;\u003c/strong\u003eAuditory Exercises\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTotal duration:\u003c/strong\u003e 5 days a week for 4 weeks\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuditory Attention Exercises: -\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e1. Auditory Word Recall:-\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e:\u003c/h3\u003e\n\u003col\u003e\n \u003cli\u003eSay a list of \u003cstrong\u003e5\u0026ndash;7 unrelated words\u003c/strong\u003e aloud (e.g., \u0026quot;dog, pen, ball, chair, moon\u0026quot;) [12].\u003c/li\u003e\n \u003cli\u003eAsk the patient to \u003cstrong\u003erepeat the words in any order [13]\u003c/strong\u003e.\u003c/li\u003e\n \u003cli\u003eIncrease difficulty: Add more words, Introduce background noise, Ask for recall \u003cstrong\u003eafter a delay [14].\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003e\u003cstrong\u003e2. Sound Matching / Sound Discrimination:\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eProcedure:\u003c/strong\u003e\u003c/h3\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003ePlay or produce two short sounds\u003c/strong\u003e (i.e., hand clap vs. book tap), and ask the patient, \u0026ldquo;Are these the same or different?\u0026rdquo; \u0026ndash; used to assess basic auditory discrimination [15,16].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIncrease difficulty\u003c/strong\u003e by using more similar sounds (e.g., different pitch, loudness) to enhance phonemic awareness [17].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUse minimal pairs\u003c/strong\u003e (e.g., \u0026ldquo;bat\u0026rdquo; vs. \u0026ldquo;pat\u0026rdquo;) and ask the patient to identify or repeat the word heard \u0026ndash; a common method in speech-language therapy [18].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eProgress\u003c/strong\u003e by incorporating pictures, delayed recall, or background noise depending on the individual\u0026rsquo;s level [15,17].\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003e\u003cstrong\u003e3. Auditory Odd-One-Out:\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e:\u003c/h3\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eSay a list of 4\u0026ndash;5 spoken words\u003c/strong\u003e (e.g., \u0026ldquo;dog, cat, apple, horse\u0026rdquo;) and ask the listener to identify the word that doesn\u0026rsquo;t belong and explain why \u0026ndash; this targets semantic categorization and reasoning [19].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUse non-verbal auditory stimuli\u003c/strong\u003e (e.g., 3 claps and 1 whistle) to train pattern recognition and sound discrimination [20].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eDual-Task Training: -\u0026nbsp;\u003c/strong\u003eDual-Task Training involves performing auditory tasks alongside another task (e.g., physical or cognitive) to enhance multitasking abilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Walking + Cognitive Task (e.g., Counting Backward)\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAsk the patient to walk\u003c/strong\u003e at a comfortable pace over a 10 m walkway.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWhile walking, have them count backward aloud\u003c/strong\u003e (i.e., from 10 to 1); this \u0026ldquo;walking while talking\u0026rdquo; paradigm is widely used to assess cognitive\u0026ndash;motor interference [21,22].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMonitor gait speed, balance, and counting accuracy\u003c/strong\u003e, focusing on dual-task costs\u0026mdash;slower speed or more counting errors indicate greater interference [21,23].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2. Tandem Walking + Spell Words\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAsk the pa\u003c/strong\u003e\u003cstrong\u003etient to walk heel-to-toe\u003c/strong\u003e (tandem gait) along a straight 3\u0026ndash;10 m line, reducing their base of support.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAsk them to spell simple words aloud\u003c/strong\u003e (e.g., \u0026ldquo;train\u0026rdquo; or \u0026ldquo;table\u0026rdquo;), forwards or backwards to increase cognitive load.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eObserve and record\u003c/strong\u003e changes in gait stability (wobbling, missteps), walking speed, and spelling performance, dual-task decrements indicate cognitive\u0026ndash;motor interference [24,25].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003ePatients Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the five patients, there were five females only, mean age of years. All five patients had a confirmed diagnosis of BPPV from an ENT specialist and were subsequently referred to the physiotherapy department for therapeutic interventions.\u003c/p\u003e"},{"header":"Case Description","content":"\u003cp\u003e\u003cstrong\u003eCase 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 24-year-old female student (BMI 21.5) with a 3-month history of recurrent positional vertigo was diagnosed with right posterior canal BPPV using the Dix\u0026ndash;Hallpike Test. She reported balance difficulty during quick turns and moderate motion sensitivity in visually complex environments. Baseline assessment revealed impaired dynamic balance (Mini-BESTest 15/28), increased visual dependence (VVAS 58/100), moderate dizziness handicap (DHI 44/100), and poor tandem gait performance (5 steps in 25 seconds). After a 4-week program combining standard repositioning maneuvers with auditory exercises (auditory word recall, sound matching/discrimination, and dual-task training such as tandem walking with spelling), she showed marked improvement, with Mini-BESTest increasing to 23/28, VVAS reducing to 45/100, DHI to 22/100, and tandem gait improving to 12 consecutive steps in 24 seconds,along with subjectively reduced dizziness during daily activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 24-year-old female student with BMI 16 experienced episodes of vertigo for 6 weeks, worsening during driving and during transitions from sitting to standing. She had left posterior canal BPPV confirmed by Dix\u0026ndash;Hallpike Test. Baseline values included \u003cstrong\u003eMini-BESTest 1\u003c/strong\u003e\u003cstrong\u003e6/28\u003c/strong\u003e, \u003cstrong\u003eVVAS 72/100\u003c/strong\u003e, \u003cstrong\u003eDHI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e68/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e11 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(30 seconds)\u003c/strong\u003e before instability. The patient underwent the same auditory training protocol emphasizing \u003cstrong\u003eAuditory Word Recall\u003c/strong\u003e\u003cstrong\u003e, Sound Matching / Sound Discrimination\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eDual-Task Training\u0026nbsp;i.e.\u0026nbsp;\u003cstrong\u003eTandem Walking + Spell Word\u003c/strong\u003e. After 4 weeks, her\u0026nbsp;postural control and confidence improved significantly. Post-therapy results showed \u003cstrong\u003eMini-BESTest 2\u003c/strong\u003e\u003cstrong\u003e4/28\u003c/strong\u003e, \u003cstrong\u003eVVAS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e58/100\u003c/strong\u003e, \u003cstrong\u003eDHI 2\u003c/strong\u003e\u003cstrong\u003e6/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait of 1\u003c/strong\u003e\u003cstrong\u003e6 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(23 seconds)\u003c/strong\u003e.\u0026nbsp;She reported better mobility in crowded environments and reduced sensitivity to visual motion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 50-year-old female housewife with BMI 26.1 had intermittent vertigo for over 2 months, triggered by rolling in bed and stair descent, diagnosed with right posterior canal BPPV, confirmed by Dix\u0026ndash;Hallpike Test. Baseline assessment revealed mild balance impairment with a \u003cstrong\u003eMini-BESTest score of 1\u003c/strong\u003e\u003cstrong\u003e7/28\u003c/strong\u003e, high visual motion sensitivity (\u003cstrong\u003eVVAS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e73/100\u003c/strong\u003e), and a \u003cstrong\u003eDHI score of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e52/100\u003c/strong\u003e. Her \u003cstrong\u003eTandem Gait Test\u003c/strong\u003e showed \u003cstrong\u003e7 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(27 seconds)\u003c/strong\u003e before deviating from the line. She completed the 4-week auditory exercise intervention focusing on \u003cstrong\u003eAuditory Word Recall\u003c/strong\u003e\u003cstrong\u003e, Sound Matching / Sound Discrimination\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eDual-Task Training\u0026nbsp;i.e.\u0026nbsp;\u003cstrong\u003eTandem Walking + Spell Word\u003c/strong\u003e. After completion, she demonstrated improved sensory\u0026nbsp;re-weighting\u0026nbsp;and movement control: \u003cstrong\u003eMini-BESTest increased to 2\u003c/strong\u003e\u003cstrong\u003e0/28\u003c/strong\u003e, \u003cstrong\u003eVVAS decreased to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e62/100\u003c/strong\u003e, \u003cstrong\u003eDHI dropped to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e50/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait improved to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e11 (23 seconds) heel-to-toe steps\u003c/strong\u003e. She reported improved stability during stair descent and reduced dizziness when lying to sitting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 37-year-old female teacher with BMI 22.7 presented with severe vertigo episodes for 1 month, particularly during head extension and rising from bed and diagnosed with \u0026nbsp;right posterior canal BPPV confirmed by Dix\u0026ndash;Hallpike Test. She exhibited poor gait stability and fear of falling. Baseline findings included \u003cstrong\u003eMini-BESTest 1\u003c/strong\u003e\u003cstrong\u003e6/28\u003c/strong\u003e, \u003cstrong\u003eVVAS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e79/100\u003c/strong\u003e, \u003cstrong\u003eDHI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e54/100 (severe handicap)\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait of only\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(26 seconds)\u003c/strong\u003e before losing balance. After participating in the auditory exercise program, that mainly includes the\u0026nbsp;\u003cstrong\u003eAuditory Word Recall\u003c/strong\u003e\u003cstrong\u003e, Sound Matching / Sound Discrimination\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eDual-Task Training\u0026nbsp;i.e.\u0026nbsp;\u003cstrong\u003eTandem Walking + Spell Word\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e significant improvements were noted at 4 weeks. Post-intervention results were \u003cstrong\u003eMini-BESTest 20/28\u003c/strong\u003e, \u003cstrong\u003eVVAS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e61/100\u003c/strong\u003e, \u003cstrong\u003eDHI 30/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait increased to 8 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(23 seconds)\u003c/strong\u003e.\u0026nbsp;She described increased confidence in walking independently and reduced dizziness during head turns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 50-year-old female homemaker with BMI 27.2 complained of episodic vertigo for 4 months, aggravated while changing any position and walking in visually stimulating environments and had left posterior canal BPPV confirmed by Dix\u0026ndash;Hallpike Test. Initial assessments indicated moderate balance deficits: \u003cstrong\u003eMini-BESTest 1\u003c/strong\u003e\u003cstrong\u003e5/28\u003c/strong\u003e, \u003cstrong\u003eVVAS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e90/100\u003c/strong\u003e, \u003cstrong\u003eDHI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e66/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e7 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(30 seconds)\u003c/strong\u003e. She underwent the 4-week intervention consisting of \u003cstrong\u003eAuditory Word Recall\u003c/strong\u003e\u003cstrong\u003e, Sound Matching / Sound Discrimination\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eDual-Task Training\u0026nbsp;i.e.\u0026nbsp;\u003cstrong\u003eTandem Walking + Spell Word\u003c/strong\u003e. At the end of treatment, she demonstrated notable functional gains. Her \u003cstrong\u003eMini-BESTest improved to 2\u003c/strong\u003e\u003cstrong\u003e0/28\u003c/strong\u003e, \u003cstrong\u003eVVAS reduced to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e79/100\u003c/strong\u003e, \u003cstrong\u003eDHI decreased to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e30/100\u003c/strong\u003e, and \u003cstrong\u003eTandem Gait improved to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e10 steps\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(27 seconds)\u003c/strong\u003e. She reported better tolerance in visually busy environments and minimal dizziness during household tasks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were assessed using outcome measures; Mini BESTest, Visual Vertigo Analogue Scale (VVAS), DHI (Dizziness Handicap Inventory), Tandem Gait Test (Heel-to-Toe Walking). Pre Assessment was conducted on the first day of patient\u0026rsquo;s presentation. Physiotherapy treatment was administered from the first day and continued for 1 week with sessions held for continuous days. Post assessment was conducted at the end of the last week from the start of the treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMini BESTest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Mini-Balance Evaluation Systems Test (Mini-BESTest) is a shorter version of the original BESTest, designed to assess dynamic balance and identify balance deficits across multiple systems. It consists of 14 tasks grouped into four domains: anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. These tasks evaluate different aspects of balance, such as standing on one leg, compensatory stepping, and walking with head turns. Each task is scored on a 3-point scale (0-2), with a maximum score of 28, where higher scores indicate better balance performance. The Mini-BESTest is widely used in clinical and research settings to assess balance in individuals with conditions such as Parkinson\u0026rsquo;s disease, stroke, and vestibular disorders. This test has the\u0026nbsp;Excellent\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003etest-retest reliability ICC = 0.96 (0.94- 0.99)\u0026nbsp;[26].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisual Vertigo Analogue Scale (VVAS):-\u0026nbsp;\u003c/strong\u003eVVAS, as a quick method of quantifying VV and monitoring its response to treatment. It consists of a battery of analogue scales to rate the intensity of VV in 9 challenging situations of visual motions that typically provoke dizziness. These 9 items are based on yes-no questions given by Longridge and Mallinson [27]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eto identify\u0026nbsp;visual vertigo. In the VVAS, the severity of symptoms is graded by analogue scales; therefore, the VVAS is a continuous scale. In a study comparing the VVAS score between vestibulopathic (n = 102) and control subjects (n = 101), we have reported that the VVAS is internally consistent and reliable (Cronbach \u0026alpha; index = 0.94)\u0026nbsp;[28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDHI (Dizziness Handicap Inventory):-\u0026nbsp;\u003c/strong\u003eThe Dizziness Handicap Inventory (DHI) is a widely used self-assessment questionnaire designed to evaluate the impact of dizziness on an individual\u0026apos;s daily life, particularly focusing on functional, emotional, and physical aspects. It consists of 25 questions that help assess how dizziness affects activities such as walking, social interaction, and concentration, along with the emotional distress it may cause. The DHI provides a total score that reflects the severity of the handicap, with higher scores indicating greater impairment. ` These results suggest that the Dizziness Handicap Inventory is a reliable, valid, and responsive instrument for the assessment of perceived disability due to dizziness.The test-retest reliability coefficient was 0.97 [29].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTandem Gait Test (Heel-to-Toe Walking):-\u0026nbsp;\u003c/strong\u003eThe Tandem Gait Test, also known as the Heel-to-Toe Walking Test, is a simple clinical assessment used to evaluate balance, coordination, and postural control. During the test, the individual is instructed to walk in a straight line, placing the heel of one foot directly in front of the toes of the other, as if walking on a tightrope. This test challenges the body\u0026apos;s ability to maintain balance by narrowing the base of support, making it more difficult to stabilize. It is often used to assess neurological function, vestibular disorders, and gait abnormalities. Difficulty completing the tandem gait may indicate issues with balance, coordination, or motor control. Heel-to-toe (ICC = 0.99, Cronbach\u0026apos;s \u0026alpha; \u0026ndash; 0.994), lateral (ICC = 0.96, Cronbach\u0026apos;s \u0026alpha; \u0026ndash; 0.988), and step-over walking (ICC = 0.96, Cronbach\u0026apos;s \u0026alpha; \u0026ndash; 0.987) demonstrated excellent intra-rater reliability [30].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe normality of the data collected from all participants was verified using SPSS software. Due to the limited number or patients, the Shapiro-Wilk test was used, and the findings showed that the data were normally distributed (p \u0026gt; 0.05). Because the normality condition was met and the data showed statistical significance, parametric analysis was done. A paired t-test was performed to compare pre- and post-intervention results. The intervention resulted to significant improvements in all assessed outcome variables (p \u0026lt; 0.05), according to the paired t-test (Table 2, Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eThe pre and post difference shows significantly improvement.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;Standard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eMini BESTest_Pre\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e15.80\u0026plusmn;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-5.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eMini BESTest_Post\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e21.40\u0026plusmn;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eVVAS_Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e74.40\u0026plusmn;11.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eVVAS_Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e61.0\u0026plusmn;12.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eDHI_Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e56.80\u0026plusmn;10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eDHI_Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e31.600\u0026plusmn;10.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eTandem gait test_Pre\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e27.60\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eTandem gait test_Post\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e24.00\u0026plusmn;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe graph shows a consistent improvement across all five cases following the intervention. Post-intervention scores increased for the Mini-BESTest and Tandem Gait Test, indicating better balance and gait performance, while VVAS and DHI scores decreased, reflecting reduced vertigo severity and dizziness-related disability. Overall, the findings suggest that the intervention was effective in improving balance, functional mobility, and reducing symptoms associated with vestibular dysfunction.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBPPV is the primary cause of peripheral vertigo (20-30% of patients), often results in sensory integration problems despite\u0026nbsp;Canalith Repositioning Maneuvers (CRM) effectiveness, with deficiencies in mediolateral stability and dual- task performance that persist. Auditory signals provide spatial- temporal input, affecting sway and gait through multisensory pathways. Rhythmic music improves motor coordination in vestibular- impaired people, similar to parkinsons\u0026rsquo;s cueing effects. Nonverbal pattern recognition (e.g., claps/whistles) and word recall exercises improve auditory- motor interaction and reduced visual dependency, as seen by VVAS/DHI decreases [31].\u003c/p\u003e\n\u003cp\u003eThis case series demonstrates that a 4-week auditory training program including sound localization, discrimination, and dual-task training activities such as tandem walking with word pronunciation significantly enhances postural control and coordination in posterior canal BPPV patients following\u0026nbsp;Canalith Repositioning Maneuvers\u0026nbsp;(CRM). Mini-BESTest scores increased from 15.8 to 21.4 (p=0.006), VVAS decreased from 74.4 to 61 (p=0.001), DHI from 56.8 to 31.6 (p=0.022), and tandem gait improved (p=0.021). These improvements demonstrate auditory training\u0026rsquo;s ability to correct residual deficits.\u003c/p\u003e\n\u003cp\u003eSupporting evidence shows auditory exercises affect posture:- rotating sounds destabilize bilateral vestibulopathy/cochlear implant patients (increased center of pressure (COP) sway) but stabilize unilateral cases, indicating binaural cues role in balance when vestibular input fails. Vestibular rehabilitation post BPPV enhances\u0026nbsp;Canalith Repositioning Maneuvers (CRM) by enhancing DHI stability, but it rarely isolates auditory components [9]. A protocol for vestibular- auditory combinations predicts superior Mini-BESTest gains, which are consistent with this case series. Unlike Brandt Daroff\u0026rsquo;s (repositioning focused) exercises, these ones focused on ecological skills for crowded environments [31].\u003c/p\u003e\n\u003cp\u003eIn this five-patient case series, all participants showed improvement in balance, gait stability, and dizziness following the intervention. Reduced visual motion sensitivity, better sensory reweighting, increased confidence, and improved tolerance to visually complex environments were consistently observed, supporting the potential value of auditory exercises as an adjunct to vestibular rehabilitation in BPPV.\u003c/p\u003e\n\u003cp\u003eClinically, auditory exercises are effective adjuncts that promote independence and fall prevention. Personalized approaches could improve BPPV rehabilitation by developing auditory-vestibular coordination for overall recovery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to this case series, auditory exercises may improve postural control and coordination in individuals with benign paroxysmal positional vertigo. Improvements were seen in all participants after individualized auditory-based therapies were applied, suggesting that auditory input may play an essential role in improving motor responses that affect balance. These results indicate that auditory stimuli could be useful in promoting brain mechanisms related to balance control and multisensory integration. Therefore, combining auditory exercises to vestibular rehabilitation therapies may help control postural instability and coordination impairments related to BPPV more effectively, suggesting its application as a therapeutically meaningful and supportive intervention method.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"579\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull form\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBPPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eBenign Paroxysmal Positional Vertigo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eCanalith Repositioning Maneuvers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVVAS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eVisual Vertigo Analogue Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDHI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eDizziness Handicap Inventory\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIEC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eInstitutional Ethics Committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eENT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eEar, Nose and Throat\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eBody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eIntraclass Correlation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eCenter of Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDr.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFollow-up and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the participants completed the four-week auditory exercise program and demonstrated improvements in postural control, balance, and coordination on post-intervention assessment. The intervention was well tolerated, with no adverse events reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cstrong\u003e:-\u003c/strong\u003e The study was approved from the Institutional Research Ethics Committee (IEC-3087) of a tertiary care teaching hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eonsent to participate\u003c/strong\u003e\u003cstrong\u003e:-\u0026nbsp;\u003c/strong\u003eWritten consent was taken from all of the participants included in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:-\u003c/strong\u003e None declared\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYetiser S (2020) Review of the pathology underlying benign paroxysmal positional vertigo. \u003cem\u003eJ Int Med Res\u003c/em\u003e 48:300060519892370. doi:10.1177/0300060519892370\u003c/li\u003e\n\u003cli\u003eSwain SK (2023) Revisiting pathophysiology of benign paroxysmal positional vertigo: a review. \u003cem\u003eInt J Otorhinolaryngol Head Neck Surg\u003c/em\u003e 9:355\u0026ndash;360. doi:10.18203/issn.2454-5929.ijohns20230773\u003c/li\u003e\n\u003cli\u003ePalmeri R, Kumar A (2022) Benign paroxysmal positional vertigo. \u003cem\u003eStatPearls\u003c/em\u003e [Internet]. Treasure Island (FL): StatPearls Publishing\u003c/li\u003e\n\u003cli\u003eAssal S, Morsy HM, Almagassbi NM, Eldeeb M (2022) Assessment of sensory organization testing in benign paroxysmal positional vertigo patients before and after repositioning manoeuvre. \u003cem\u003eActa Otorrinolaringol Esp\u003c/em\u003e 73:210\u0026ndash;218. doi:10.1016/j.otoeng.2021.04.002\u003c/li\u003e\n\u003cli\u003eDi Girolamo S, Ottaviani F, Scarano E, Picciotti P, Di Nardo W (2000) Postural control in horizontal benign paroxysmal positional vertigo. \u003cem\u003eEur Arch Otorhinolaryngol\u003c/em\u003e 257:372\u0026ndash;375. doi:10.1007/s004050000243\u003c/li\u003e\n\u003cli\u003eKasse CA, Santana GG, Scharlach RC, Gazzola JM, Branco FC, Don\u0026aacute; F (2010) Results from the balance rehabilitation unit in benign paroxysmal positional vertigo. \u003cem\u003eBraz J Otorhinolaryngol\u003c/em\u003e 76:623\u0026ndash;629. doi:10.1590/S1808-86942010000500015\u003c/li\u003e\n\u003cli\u003eŞahin ET, Orhan E, Tutar V, Tutar H, G\u0026uuml;nd\u0026uuml;z B (2024) The effect of different sensory perturbations on postural control and fall risk in benign paroxysmal positional vertigo patients. \u003cem\u003eAm J Audiol\u003c/em\u003e 33:874\u0026ndash;881\u003c/li\u003e\n\u003cli\u003eSharma A, Sharma N, Kapri P (2025) Determining the effect of vestibular and auditory exercises on postural control and coordination among individuals with benign paroxysmal positional vertigo: a three-arm single-blinded study protocol. \u003cem\u003eJ Clin Diagn Res\u003c/em\u003e 19\u003c/li\u003e\n\u003cli\u003eBressi F, Vella P, Casale M, Moffa A, Sabatino L, Lopez MA et al (2017) Vestibular rehabilitation in benign paroxysmal positional vertigo: reality or fiction? \u003cem\u003eInt J Immunopathol Pharmacol\u003c/em\u003e 30:113\u0026ndash;122. doi:10.1177/0394632017709917\u003c/li\u003e\n\u003cli\u003eWorld Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. \u003cem\u003eJAMA\u003c/em\u003e 310:2191\u0026ndash;2194. doi:10.1001/jama.2013.281053\u003c/li\u003e\n\u003cli\u003eMathur R, Swaminathan S (2018) National ethical guidelines for biomedical and health research involving human participants, 2017: a commentary. \u003cem\u003eIndian J Med Res\u003c/em\u003e 148:279\u0026ndash;283. doi:10.4103/ijmr.IJMR_1627_18\u003c/li\u003e\n\u003cli\u003eSeniorSite (2010) Understanding the 5-word memory test. https://seniorsite.org/resource/understanding-the-5-word-memory-test. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eCarepatron (2010) Memory test. https://www.carepatron.com/files/memory-test.pdf. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eUniversity of Washington Alzheimer\u0026rsquo;s Disease Research Center (2010) UDS3 neuropsychological test instructions. https://files.alz.washington.edu/documentation/uds3-np-c2t-instructions.pdf. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eForbrain (2010) Speech therapy activities: minimal pairs. https://www.forbrain.com/speech-therapy-for-kids/activities/minimal-pairs/. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eTeachers Pay Teachers (2010) Auditory discrimination hierarchy: minimal pairs resource. https://www.teacherspayteachers.com/Product/Auditory-Discrimination-Hierarchy-Minimal-Pairs-Resource-300237. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eCommuniKids Speech Pathology (2010) Minimal pairs therapy. https://www.communikidsspeech.com.au/blog/minimal-pairs-therapy. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eSpeech-Language-Therapy.com (2010) Word retrieval therapy. https://www.speech-language-therapy.com/index.php?option=com_content\u0026amp;view=article\u0026amp;id=100:wordretrieval. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eCornsweet T, Thompson M (2012) Adaptive maximal pair discrimination assessment (AXB nonword odd-one-out procedure). University College London. https://discovery.ucl.ac.uk/id/eprint/10178734/1/WA_aud%20discrim_final%20submission.pdf. Accessed 10 July 2010.\u003c/li\u003e\n\u003cli\u003eGovaerts PJ et al (2006) Auditory speech sound discrimination tests. \u003cem\u003eCochlear Implants Int\u003c/em\u003e 7:87\u0026ndash;97. doi:10.1002/cii.177 \u003c/li\u003e\n\u003cli\u003eMontero-Odasso M, Verghese J, Beauchet O, Hausdorff JM (2012) Gait and cognition: a complementary approach to understanding brain function and the risk of falling. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e 60:2127\u0026ndash;2136. doi:10.1111/j.1532-5415.2012.04209.x\u003c/li\u003e\n\u003cli\u003eSuk HS, Lee SH, Kim JY, Park KR (2021) Dual-task walking while counting backward: effects on gait and cognitive performance among older adults. \u003cem\u003eFront Aging Neurosci\u003c/em\u003e 13:731997. doi:10.3389/fnagi.2021.731997\u003c/li\u003e\n\u003cli\u003eCanadian Geriatrics Society (2017) Guidelines for gait assessments in older adults: dual-task protocol\u0026mdash;walking while counting backward. \u003cem\u003eCan Geriatr J\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eHowell D, Wilson J, Meehan WP Jr, Brilliant AN (2017) Dual-task and tandem gait performance post-concussion: using concurrent cognitive tasks to reveal persistent postural control deficits. \u003cem\u003eJ Neurol Neurosurg Psychiatry\u003c/em\u003e 88:479\u0026ndash;485. doi:10.1136/jnnp-2017-315415\u003c/li\u003e\n\u003cli\u003eShumski E, Schmidt JD, Lynall RC et al (2023) Cognition uniquely influences dual-task tandem gait performance among athletes with a concussion history. \u003cem\u003eSports Health\u003c/em\u003e 15:212\u0026ndash;219. doi:10.1177/19417381231230071\u003c/li\u003e\n\u003cli\u003eGodi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A (2013) Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders. \u003cem\u003ePhys Ther\u003c/em\u003e 93:158\u0026ndash;167\u003c/li\u003e\n\u003cli\u003eLongridge NS, Mallinson AI (2005) Visual vestibular mismatch in work-related vestibular injury. \u003cem\u003eOtol Neurotol\u003c/em\u003e 26:691\u0026ndash;694\u003c/li\u003e\n\u003cli\u003eDannenbaum E, Chilingaryan G, Fung J (2011) Visual Vertigo Analogue Scale: an assessment questionnaire for visual vertigo. \u003cem\u003eJ Vestib Res\u003c/em\u003e 21:153\u0026ndash;161\u003c/li\u003e\n\u003cli\u003eKarapolat H, Eyigor S, Kirazlı Y, Celebisoy N, Bilgen C, Kirazli T (2009) Reliability, validity and sensitivity to change of Turkish Dizziness Handicap Inventory in patients with unilateral peripheral vestibular disease. \u003cem\u003eJ Int Adv Otol\u003c/em\u003e 5\u003c/li\u003e\n\u003cli\u003eKoyama S, Tanabe S, Itoh N et al (2018) Intra- and inter-rater reliability and validity of the tandem gait test for the assessment of dynamic gait balance. \u003cem\u003eEur J Physiother\u003c/em\u003e 20:135\u0026ndash;140\u003c/li\u003e\n\u003cli\u003eGuigou C, Toupet M, Delemps B, Heuschen S, Aho S, Bozorg Grayeli A (2018) Effect of rotating auditory scene on postural control in normal subjects, patients with bilateral vestibulopathy, unilateral, or bilateral cochlear implants. \u003cem\u003eFront Neurol\u003c/em\u003e 9:972. doi:10.3389/fneur.2018.00972\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Benign Paroxysmal Positional Vertigo, Dizziness, Postural Balance, Gait, Sound Localization","lastPublishedDoi":"10.21203/rs.3.rs-8761555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8761555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBenign Paroxysmal Positional Vertigo (BPPV) is characterized by brief episodes of vertigo triggered by head movements and is commonly associated with impairments in postural control and coordination. Although canalith repositioning maneuvers(CRM) are the primary treatment, residual balance deficits may persist, highlighting the need for adjunct rehabilitation strategies. Auditory-based exercises may facilitate multi-sensoryintegration and enhance balance control; however, evidence supporting their role in BPPV rehabilitation remains limited. This case series aimed to estimate the impact of a structured auditory exercise program on postural control and coordination in individuals with BPPV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive individuals aged 20–50 years diagnosed withright or left posterior canal BPPV were included in this case series. All participants initially underwent standard canalith repositioning maneuvers (CRM), followed by a four-week auditory training program consisting of auditory attention tasks, spatial sound localization exercises, and dual-task auditory–motor coordination activities (30 minutes per day, five days per week). Outcome measures assessed pre- and post-intervention included the Mini-Balance Evaluation Systems Test (Mini-BESTest) for dynamic postural control, the Visual Vertigo Analogue Scale (VVAS) for visual-induced dizziness, the Dizziness Handicap Inventory (DHI) for dizziness-related functional limitations, and the Tandem Gait Test for gait coordination. Post-intervention assessments demonstrated consistent improvements across all outcomes. Mean Mini-BESTest scores increased from 15.8 (median 16) to 21.4 (median 20), VVAS scores decreased from mean 74.4 (median 73) to 61 (median 61), DHI scores decreased from mean 56.8 \u0026nbsp;(median 54) to 31.6 \u0026nbsp;(median 30), and tandem gait steps increased from mean 6.8 (median 6) to 11.4 (median 11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case series indicates that auditory-based exercises, when combined with standard canalith repositioning maneuvers, may positively influence postural control, reduce dizziness-related symptoms, and improve gait coordination in individuals with BPPV. These findings suggest a potential role for auditory exercises as a complementary intervention within vestibular rehabilitation programs aimed at enhancing balance and coordination outcomes in this population.\u003c/p\u003e","manuscriptTitle":"Effect of Auditory Exercises on postural control and co-ordination among individuals with Benign Paroxysmal Positional Vertigo:- A case series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-31 17:41:46","doi":"10.21203/rs.3.rs-8761555/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5ef3721-8c7e-4812-a38a-bad1f7f31e93","owner":[],"postedDate":"March 31st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-17T17:09:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-31 17:41:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8761555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8761555","identity":"rs-8761555","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}