rTMS Plus Vestibular Rehabilitation as an Adjunct Treatment for Fall Risk and Postural Instability for Chronic Vestibular Dizziness Patients/ Chronic Labyrinthitis (rTMS)

Inclusion Criteria: Diagnosis with peripheral vestibular disorders from audiologist or neurologist. The patient's age will be ranged from forty to sixty five years old. Patients will experience at least two symptoms of common symptoms of peripheral vestibular disorders. Symptoms of vertigo and nystagmus lasting from seconds to one minute. Vertigo that arises from changes in head position related to gravity. Patients who experienced symptoms for more than three months (chronic patients) Patients were selected to be ambulant. Patients suffer from balance disturbance with low risk falling (41-56) and moderate risk falling ranges (21-40) according to berg balance scale. All patients were medically stable, controlled with medical drugs for at least three months and failed to medical treatment with no other physical, mental or cognitive disorders. Exclusion Criteria: Central vestibular disorders ( Ms, ataxia, migraine headache, posterior inferior cerebellar artery syndrome "PICA"). Vertigo that arises from changes in head position not related to gravity; as vertigo of cervical origin or vascular origin ( Vertebro- basilar insufficiency "VBI"). Previous surgery of the ear. Bilateral peripheral vestibular weakness, central vestibular weakness, mixed vestibular weakness, or acute vestibular weakness. Unstable health issues (cardiac dysfunction, end stage renal failure, unstable diabetes, uncontrolled hypertension >190/110…). Pacemaker or other implanted electrically sensitive device. Significant orthopedic or chronic pain syndrome (e.g any condition that wouldn't permit to completion of any of the tests). Major cognitive dysfunction. neurodegenerative disease or major psychiatric condition ( Alzheimer's disease , depression….). Chronic use of medications that could influence motor or sensory excitability (e.g AEDs, antipsychotic). Alcohol abuse. Epilepsy.