Bilateral vestibulopathy: beyond imbalance and oscillopsia

Abstract

Objective To optimize the current diagnostic and treatment procedures for patients with bilateral vestibulopathy (BV), this study aimed to determine the complete spectrum of symptoms associated with BV. Method A prospective mixed-method study design was used. Qualitative data were collected by performing semi-structured interviews about symptoms, context, and behavior. The interviews were recorded and transcribed until no new information was obtained. Transcriptions were analyzed in consensus by two independent researchers. In comparison to the qualitative results, quantitative data were collected using the Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS) and a health-related quality of life questionnaire (EQ-5D-5L). Results Eighteen interviews were transcribed. Reported symptoms were divided into fourteen physical symptoms, four cognitive symptoms, and six emotions. Symptoms increased in many situations, such as darkness (100%), uneven ground (61%), cycling (94%) or driving a car (56%). These symptoms associated with BV often resulted in behavioral changes: activities were performed more slowly, with greater attention, or were avoided. The DHI showed a mean score of severe handicap (54.67). The HADS questionnaire showed on average normal results (anxiety = 7.67, depression = 6.22). The EQ-5D-5L demonstrated a mean index value of 0.680, which is lower compared to the Dutch age-adjusted reference 0.839 (60–70 years). Conclusion BV frequently leads to physical, cognitive, and emotional complaints, which often results in a diminished quality of life. Importantly, this wide range of symptoms is currently underrated in literature and should be taken into consideration during the development of candidacy criteria and/or outcome measures for therapeutic interventions such as the vestibular implant.

Genotype-Phenotype Correlation Study in a Large Series of Patients Carrying the p.Pro51Ser (p.P51S) Variant in COCH (DFNA9) Part II: A Prospective Cross-Sectional Study of the Vestibular Phenotype in 111 Carriers

“…Bilateral vestibulopathy (BVP) is a chronic vestibular syndrome characterized by a bilaterally absent or partially reduced vestibular function ( Strupp et al 2017 ). The leading symptoms of BVP are oscillopsia, postural imbalance, and gait unsteadiness exacerbated by visual deprivation or when walking on uneven ground ( Strupp et al 2017 ; Dobbels et al 2019 ; Lucieer et al 2020 ). Oscillopsia is caused by impairment of the vestibulo-ocular reflex (VOR), which is essential for gaze stabilization ( Hermann et al 2018 ).…”

DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy

“…Most DISCOHAT symptoms were frequently reported by both BVP and UVP patients. In a previous study using semistructured qualitative interviews, these symptoms were already identified as being frequently present in BVP patients (6). Since the DISCOHAT acronym was not used in the previous study, this current study explicitly used a different group of BVP patients to externally validate the DISCOHAT acronym.…”

“…A BVP-specific questionnaire is unfortunately not (yet) available. Based on a previous study (6), this study therefore proposes an acronym that is able to easily and quickly capture a spectrum of symptoms in clinic, directly related to vestibulopathy: DISCOHAT. The acronym includes: Darkness: worsening of symptoms in darkness and/or on uneven ground (1) Imbalance: unsteadiness when walking or standing (1) Supermarket effect: visually induced dizziness: intolerance to busy visual environments Cognitive complaints: difficulties with memory, concentrating, dual-tasking, navigation, etc.…”

“…The diagnosis BVP can be challenging and it is therefore often missed or misdiagnosed ( 5 ). One of the main challenges of diagnosing BVP, is the fact that disorders resulting in BVP can have different clinical presentations: patients can present with and without vertigo ( 6 ), and while imbalance and oscillopsia are the most well-known symptoms of BVP ( 7 ), a wide spectrum of other symptoms can be present in BVP patients ( 8 ). For example, visually induced dizziness (previously called “the supermarket effect”) involving dizziness triggered by visual stimuli like fast moving objects and certain patterns, is often reported ( 9 ).…”

Radiological Configuration of the Vestibular Aqueduct Predicts Bilateral Progression in Meniere's Disease

“…Most severely affected are the 10-50% of patients (3)(4)(5) in whom the disease progresses to bilateral MD, often years to decades after its initial (unilateral) manifestation. Due to bilateral vestibulopathy, patients with bilateral MD experience chronic debilitating vestibular symptoms, such as oscillopsia and imbalance, and a broad range of cognitive and emotional impairment (6). Moreover, bilateral MD often leads to severe to profound hearing loss with unserviceable speech discrimination (7,8).…”