Follow-up of vestibular function in bilateral vestibulopathy

Abstract

Objective: Bilateral vestibulopathy (BV) leads to a bilateral deficit of the vestibulo-ocular reflex and has various aetiologies. The main goal of this study was to determine the frequency and degree of recovery or worsening of vestibular function over time. Methods: 82 patients (59 males, 23 females; mean age at the time of diagnosis 56.3 (SD 17.6) years) were reexamined 51 (36) months after the first examination. All patients underwent a standardised neuro-ophthalmological and neuro-otological examination. Electronystagmography with bithermal caloric irrigation was analysed by measurement of the mean peak slow phase velocity (SPV) of the induced nystagmus. Patients evaluated the course of their disease in terms of balance, gait unsteadiness and health related quality of life. Results: Statistical analysis of the mean peak SPV of caloric induced nystagmus revealed a non-significant worsening over time (initial mean peak SPV 3.0 (3.5)u/s vs 2.1 (2.8)u/s). With respect to subgroups of aetiology, only patients with BV due to meningitis exhibited an increasing, but non-significant SPV (1.0 (1.4)u/s vs 1.9 (1.6)u/s). Vestibular outcome was independent of age, gender, time course of manifestation and severity of BV. Single analysis of all patients showed that a substantial improvement >5u/s occurred in two patients on both sides (idiopathic n = 1, Sjögren's syndrome n = 1) and in eight patients on one side (idiopathic n = 6, meningitis n = 1, Menière's disease n = 1). In 84% of patients there was impairment of their health related quality of life (42% slight, 24% moderate, 18% severe). Forty-three per cent of patients rated the course of their disease as stable, 28% as worsened and 29% as improved. Conclusions: Our data support the view that more than 80% of patients with BV do not improve. Thus the prognosis of BV is less favourable than assumed.

Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults

“…The impact of BVH on quality of life is still controversial, and the handicap is not always recognized [8,21,45]. Even the recent literature still reports on patients who underwent a bilateral vestibular neurectomy [46].…”

“…Postural control and spatial orientation depend on vestibular, visual and proprioceptive inputs and on internal estimates based on motor efference. Due to failure of the vestibulospinal reflex in BVH, the multisensory process of postural control is hindered [5,7,21,22,59]. Especially fast corrections become impaired, and the accuracy of gravity detection decreases.…”

“…Nowadays, this symptom complex is known to have many causes, and BVH probably represents a functionally heterogeneous disorder with different combined or isolated deficits of the semicircular canals and/or otolith organs [18]. Most of the etiologies described are presented in table 1[12,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44]. However, its etiology still remains unclear in approximately 50% of all cases [7,19].…”

Vestibular Implants: 8 Years of Experience with Electrical Stimulation of the Vestibular Nerve in 11 Patients with Bilateral Vestibular Loss

“…Moreover, due to multifocal cortical and thalamic projections of vestibular afferents, emotions, memory, cognitive abilities and personality can also be affected [3,4,5]. In most cases, a BVL cannot be compensated and sensory substitution is insufficient so that there is no or little spontaneous improvement to be expected in the long term [6]. As a consequence, BVL imposes a significant social and economic burden on patients and society [7].…”

Cervical proprioception is sufficient for head orientation after bilateral vestibular loss

“…Malfunction in one sensory system may be compensated for by the other sensory systems (Buchanan and Horak 2001;Curthoys 2000;Lacour et al 1997;Schweigart et al 2002;Yagi et al 2000) and by the brain weighting sensory information diVerently (Curthoys and Halmagyi 1995;Lacour et al 1997;Peterka and Loughlin 2004), but complete restitution of sensorimotor function by these means is less common (Allum et al 2008;Buchanan and Horak 2001;Curthoys 2000;Karlberg and Magnusson 1998;Zingler et al 2008). A vestibular debility increases dependence on the remaining sensory inputs.…”