Bilateral vestibulopathy[1] may also be referred to as bilateral vestibular hypofunction (BVH) or bilateral vestibular loss (BVL). It is the reduction or absence of balance (vestibular) function in both ears.
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What are the symptoms of bilateral vestibulopathy?
Symptoms can include imbalance, unsteadiness and blurred or jumpy vision or difficulties with focusing during head movements. Other symptoms may include fatigue, neck ache, brain fog, or disorientation.
If the balance organ is not working correctly, the brain has to compensate for this lack of information and relies more on the visual (eyes) and physical (sensation from where our joints are in space) data. In bilateral vestibulopathy, the head-motion sensors in the inner ear are not working so the brain loses its ‘steadycam’, making images ‘jumpy’ or ‘bouncy’ (this is called ‘oscillopsia’) when they are moving around. Hearing loss and tinnitus are not common features of bilateral vestibular loss/hypofunction.
What causes bilateral vestibulopathy?
There are many causes of bilateral vestibulopathy, including:
- Inner ear damage (e.g. from medication, such as certain antibiotics like gentamicin)
- Autoimmune disease, or conditions that cause inflammation to the inner ear over time
- Other conditions, including, for example, Ménière’s disease; acoustic neuroma; meningitis; otosclerosis; Paget’s disease
- Genetic or congenital abnormalities
- Or it may be idiopathic (have no current identifiable cause).
How is bilateral vestibulopathy diagnosed?
As well as assessing your medical history, patients may undergo tests to assess vestibular function, such as a video head impulse test, caloric, or rotatory chair test. Your vision may also be assessed.
How is bilateral vestibular hypofunction/loss treated?
Treatment can vary and may include:
- Vestibular (balance) exercises
- Visual exercises
- Relaxation techniques
Some people may find lifestyle adjustments helpful, such as removing loose rugs, using nightlights and handrails. For some a walking stick/pole or walker may be beneficial.
Are there are long term effects?
The prognosis is highly variable depending on the cause, but for many the symptoms may be lifelong. Those who do not recover spontaneously may benefit from vestibular physiotherapy which can help the brain compensate with the lack of vestibular information it receives. Some people may need to take extra care if they find certain activities difficult, such as walking in the dark or on uneven surfaces, or riding a bike.
References
[1] Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, Della Santina CC, Kingma H. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2017;27(4):177-189. doi: 10.3233/VES-170619. PMID: 29081426.
Additional links (last accessed 05/08/2024)
- https://www.menieres.org.uk/news/entry/187/balance-disorder-spectrum
- https://hearinghealthmatters.org/pathways/2014/bilateral-vestibular-hypofunction-interesting-problem/
- https://www.frontiersin.org/articles/10.3389/fneur.2018.00344/full
- https://dizziness-and-balance.com/disorders/bilat/bilat.html
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Please note, the Ménière's Society can provide general information, but is unable to provide specific medical advice. You should always check with your medical professional for information and advice relating to your symptoms/condition.
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