Bilateral vestibulopathy treatment: update and future directions

Mohamed Fawzy,Ahmed Khater

doi:10.4103/1012-5574.181082

Abstract

Bilateral vestibulopathy or BVH is a disorder of both labyrinths and/or vestibular nerves which have various etiologies. BVH is most often a chronic condition in which patients can suffer from blurred vision (oscillopsia), impaired spatial orientation and postural instability. Moreover, there is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions. Those symptoms lead to an important decrease in physical activity, social functioning and vitality that dramatically impact the patients’ quality of life. The treatment options for various forms of BVH could be one of the following four lines of treatment: (a) Preventive treatment through prevention of ototoxicity, (b) therapeutic treatment through medical treatment of the causative underlying disease, (c) rehabilitative treatment through the vestibular rehabilitation therapy, (d) future directions through sensory substitution devices (balance prostheses technology). The prognosis of BVH is poor and more than 80% of the patients do not improve. The aim of this study was to discuss the update and the future directions in the treatment of the bilateral vestibular hypofunction (BVH).

Highlights

Bilateral vestibulopathy or bilateral vestibular hypofunction (BVH) is a disorder of both labyrinths and/or vestibular nerves which has various etiologies
A chronic bilateral loss of vestibular function is surprisingly well tolerated. This is due to the fact that spatial orientation, posture, and eye movements are mediated by redundant multisensory processes, which can in part compensate for each other’s deficiencies
There is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions [2]

Summary

Background

Bilateral vestibulopathy or bilateral vestibular hypofunction (BVH) is a disorder of both labyrinths and/or vestibular nerves which has various etiologies. A chronic bilateral loss of vestibular function is surprisingly well tolerated This is due to the fact that spatial orientation, posture, and eye movements are mediated by redundant multisensory processes, which can in part compensate for each other’s deficiencies. A permanent loss of vestibular function is the most frequent form; patients with BVH remain largely asymptomatic until confronted with high-frequency motion conditions or situations where proprioceptors or vision cannot replace the deficient vestibular system [5]. The diagnosis is made with the simple bedside test for defective vestibulo-ocular reflex during rapid, passive head turns (head thrust test) [3] It is confirmed by the absence of nystagmic reaction to both caloric. (d) Future directions through sensory substitution devices (balance prostheses technology) [7]

Preventive treatment

Therapeutic treatment

Rehabilitative treatment

Exercises to improve static and dynamic postural stability

Vestibular implant