All you need to know on bilateral vestibular dysfunction

Bilateral vestibular dysfunction

Learn about what bilateral vestibular dysfunction is and what treatment options are available. This vestibular condition requires a different approach due to the nature of the condition. Learn more about this lesser known vestibular condition below.

What is bilateral vestibular dysfunction

Bilateral vestibular dysfunction (BVD) is also known and bilateral vestibular loss (BVL) or bilateral vestibular hypofunction (BVH). This is when both our left and right vestibular systems are affected by an event that results in reduced function. This impacts about 4% of individuals that have a vestibular disorder.

Bilateral vestibular dysfunction can be a result of:

• genetics/congenital inheritance
• bilateral neuritis (super rare but technically could happen)
• bilateral Meniere’s disease
• surgical
• ototoxicity
• undetermined reason (50% of the time we just don’t know why) [1]

Typically with bilateral vestibular loss, dizziness is not a main symptom. Balance tends to be the main concern that brings someone to the doctor. Those with bilateral vestibular loss tend to experience:

• imbalance and unsteadiness. Especially in darkness
• trouble with balance and walking on uneven surfaces. Darkness makes this even more challenging
• oscillopsia or “bouncing vision”
• little to no dizziness
• Challenging to perform daily tasks and activities.

I have bilateral vestibular dysfunction, what type of progress can I expect?

The difference in bilateral vestibular loss is that both vestibular systems are impacted. This makes progress variable. With both systems impacted, it’s difficult to get the benefits of adaptation and habituation that is utilized in vestibular rehabilitation therapy (VRT) when only 1 vestibular system is involved.

VRT can still be beneficial. The goal is to promote the maximum amount of habituation and adaptation as possible while also working on ways to compensate for BVL. This helps many return to functional daily activities, but it most likely doesn’t look exactly how someone performed the activity prior to BVL. [2]

Bilateral vestibular dysfunction treatment options

As mentioned above, treatment will look different for those with BVL. Vestibular therapy will trial various VRT exercises to promote as much adaptation as possible. Finding ways to substitute and compensate movements will be a major focus of treatment. The goal of these compenstations is to get people back to their daily routines and activities, just in a slightly different way.

This might include using motion sensor night lights in the home to promote safe walking at night, or use of a hiking pole for safe walking on uneven surfaces. A popular hiking pole brand that physical therapists have recommended to me are linked here.

Part of treatment will be finding exercises to promote overall health and activity. Exercising and movement has many benefits to our overall health and well being. An animal study looking animals with BVL showed that animals who exercised on a regular basis were able to return to normal movement and ability. This might not happen exactly in the same way in humans, but movement is important! [3]

Another area of treatment undergoing development is surgical implants. These surgical implants act as vestibular prosthesis. There’s been great results and improvement in mobility, reduced falls, and overall quality of life at 6 months and 1 year out from surgery. There are a few clinical trials going on with the goal of making this an available treatment option for the public.

Disclaimer

Want to learn more about bilateral vestibular dysfunction and other vestibular tools from the experts and be a part of a supportive community to get back to your daily life?  Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Sources:

(1) Lee SU, Kim HJ, Kim JS. Bilateral Vestibular Dysfunction. Semin Neurol. 2020 Feb;40(1):40-48. doi: 10.1055/s0039-3402066. Epub 2020 Jan 14. PMID: 31935769.

(2) McCall AA, Yates BJ. Compensation following bilateral vestibular damage. Front Neurol. 2011 Dec 27;2:88. doi: 10.3389/fneur.2011.00088. PMID: 22207864; PMCID: PMC3246292.

(3) Igarashi M, Ishikawa K, Ishii M, Yamane H. Physical exercise and balance compensation after total ablation of vestibular organs. Prog Brain Res. 1988;76:395-401. doi: 10.1016/s0079-6123(08)64526-4. PMID: 3217529.

(4) Chow MR, Ayiotis AI, Schoo DP, Gimmon Y, Lane KE, Morris BJ, Rahman MA, Valentin NS, Boutros PJ, Bowditch SP, Ward BK, Sun DQ, Treviño Guajardo C, Schubert MC, Carey JP, Della Santina CC. Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant. N Engl J Med. 2021 Feb 11;384(6):521-532. doi: 10.1056/NEJMoa2020457. PMID: 33567192; PMCID: PMC8477665