Bilateral Idiopathic Loss of Peripheral Vestibular Function with Normal Hearing

Abstract

From 1982 to 1993, 52 electronystagmograms (FNG) revealed an absent nystagmic reaction on both caloric (44 30 and 10 degrees C water irrigation) and rotatory pendular testing (0.05 Hz/peak velocity 60 degrees/s), which represents 0.6% of all FNG performed during this period. Among these examinations, 14 patients (27%) presented a bilateral idiopathic loss of vestibular function (BILVF) with normal hearing and without associated neurological symptoms. Two different groups emerged: one group with simultaneous onset of BILVF ( 10 patients), with sudden imbalance and disequilibrium, worse in darkness, with an absence of bilateral caloric and pendular response. The other group (4 patients) was characterized by sequential onset of BILVF. These patients experienced several episodes of acute vertigo with persistent imbalances caloric and pendular responses showed unilateral, then contralateral loss with or without recovery of function. Eleven were controlled with a follow-up from 1 to 7 years. Patients of both groups remained permanently or episodically symptomatic, but only 4 patients complained of persistent oscillopsia. Viral infections, systemic diseases (hypertension, hypothyroidism, asthma), immune reactions (vaccination) and toxic factors (herbicide exposure) may play a role in the etiology of this rare bilateral peripheral vestibulopathy.

Follow-up of vestibular function in bilateral vestibulopathy

“…Complete recovery did not occur in any of the patients. 5 Improvement of vestibular function was also described in single cases of different aetiologies, 9 in particular when BV was caused by serous rather than suppurative destructive labyrinthitis. 4 10 11 In contrast, in a 5 year follow-up study 7 of seven patients with BV, Baloh et al did not find significant improvement in vestibular excitability.…”

“…BV is a rare vestibular disorder of various aetiologies (eg, ototoxic drugs, meningitis or Menière's disease). [4][5][6] Despite intensive examinations, the aetiology remains unclear in approximately 50%. 6 Little is known about the course of the disease, especially the recovery.…”

Arreflexia pós-calórica bilateral: aplicabilidade clínica da reabilitação vestibular

“…A ausência completa de resposta na prova calórica e ou na prova rotatória pendular decrescente é achado raro em pacientes com queixa de vertigem e desequilíbrio 1,10 . Essa baixa freqüência justifica a escassez de literatura sobre o assunto, o tamanho da nossa amostra, e a dificuldade de se conduzir ensaios clínicos prospectivos.…”

“…A perda bilateral da função vestibular periférica é rara em pacientes com queixa de vertigem e desequilíbrio, e representa 0,6% das eletronistagmografias 1 . As prováveis causas da AVB estão relacionadas ao uso de ototóxicos, traumas, meningite, infecção labiríntica, tumores bilaterais (schwanoma vestibular), otosclerose, hidropisia endolinfática, cirurgia otológica, doença auto-imune e idiopática 2,3 .…”

“…As prováveis causas da AVB estão relacionadas ao uso de ototóxicos, traumas, meningite, infecção labiríntica, tumores bilaterais (schwanoma vestibular), otosclerose, hidropisia endolinfática, cirurgia otológica, doença auto-imune e idiopática 2,3 . Dentre todas as etiologias citadas, a mais freqüente é a ototoxicidade, responsável por 21% dos casos 1 . Os principais sintomas descritos na AVB incluem a oscilopsia e o desequilíbrio.…”