Abstract
Bilateral vestibular weakness (BVW) is a rare cause of imbalance. Patients with BVW complain of oscillopsia. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Treatment of BVW is largely supportive. Medications with the unintended effect of vestibular suppression should be avoided.
Highlights
Reduced or absent vestibular function on both sides, resulting from deficits in the labyrinths, or vestibular nerves, or their combination, is referred to in the recent consensus statement from the Bárány Society [1] as “bilateral vestibulopathy.” much of the literature designates this phenomenon “bilateral vestibular loss,” that phrase is inappropriate when the deficit is partial rather than complete
Gentamicin ototoxicity affects the entire labyrinth, whereas bilateral sequential vestibular neuritis tends to involve the superior divisions of the vestibular nerves
The etiologies of bilateral vestibular weakness (BVW) are usually listed as including ototoxicity, autoimmune inner ear disease (AIED), bilateral versions of what are more commonly unilateral diseases, with the remainder designated
Summary
Bilateral vestibular weakness (BVW) is a rare cause of imbalance. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Medications with the unintended effect of vestibular suppression should be avoided. Reviewed by: Jorge Kattah, University of Illinois College of Medicine, United States. Specialty section: This article was submitted to Neuro-Otology, a section of the journal Frontiers in Neurology
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