Bilateral Vestibular Hypofunction
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Description
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Bilateral vestibular hypofunction (BVH) is a heterogeneous condition that results from defects in either both labyrinths (vestibular organs), both eighth cranial nerves or a combination of the two.[1][2][3] This condition causes impairments in the vestibulo-ocular reflex (VOR) and the major functions of the vestibular organs. Due to the loss or diminished function, patients may present with imbalance, oscillipsia and impaired spatial orientation.[2] Depending on the cause, individuals may also present with neurological and auditory symptoms.[2] Prognosis is determined by the severity of this condition, which is dependent on the number of underlying comorbidities.[4] Individuals with initial poor falls risk scores, lower balance confidence, and greater disequilibrium tend to have poorer disability that may influence functionality in everyday life.[4]
Due to the heterogeneity of the disease, BVH has four clinical subtypes:[2][3]
- Recurrent vertigo and BVH
- Rapidly progressive BVH
- Slowly progressive BVH
- BVH with neurological deficits
Epidemiology[edit | edit source]
BVH is an uncommon condition that is frequently misdiagnosed or underdiagnosed.[3] The reported prevalence of BVH in literature ranges from 28 to 81 per 100 000 US adults, with greater prevalence seen in women and Hispanics.[2][3][5] Individuals diagnosed with BVH are more likely to present with social, physical and functional impairments and limitations.[5]
Etiology/Causes[edit | edit source]
BVH is often a secondary condition from a wide spectrum of causes as listed in Table 1 below. Majority of BVM cases, about 51%, are idiopathic in nature because an underlying cause cannot be identified.[2][3][4] Of the known determinants, toxic/metabolic (13-21% of cases) is the most common and an example of this is ototoxicity, where the side effect of antibiotics, particularly aminoglycoside, results in persisting deficits (BVH).[2][3][4] Other known causes may be the result of an infection (3.8-12%) such as meningitis, and encephalitis.[2][3][4]
Clinical Presentation[edit | edit source]
add text here relating to diagnostic tests for the condition
Diagnostic Procedures [edit | edit source]
Currently, there is no standardized procedure implemented for diagnosing BVH by healthcare professionals due to the challenges faced with diagnosing, as patients present with a broad spectrum of signs and symptoms.[2][3][6] However, symptoms specific to, and commonly reported by patients include ; oscillopsia (strong indicator of BVH), unsteadiness, episodic and spontaneous vertigo.[6]
Vestibular tests performed to help diagnose BVH:[2][3]
- Caloric Test
- Rotatory Chair Test
- Head Impulse Test (HIT)
- Vesitbular-Evoked Myogenic Potentials (VEMP)
- Dynamic Visual Acuity Test (DVA)
- Torsion Swing Test
Other tests conducted to aid in determining the cause:[2]
- Cerebral imaging
- Audiometry
- Blood Tests
Medical Management
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Management of patients in the acute phase involves the use of vestibular suppressants and anti-emetics.[7] However, currently the use of medications for chronic BVH is not supported by evidence.[7]
Physiotherapy Management/Intervention[edit | edit source]
add text here relating to the differential diagnosis of this condition
Outcome Measures [edit | edit source]
Outcome measures are based on the International Classification of Function Model.[1][8]
Common outcome measures influencing the Body Structure and Function level in the ICF model:[1][9]
- Dynamic Visual Acuity Test (Level 3 = recommended)
- Sensory Organization Testing
- Dynamic Posturography
Common measures determining one’s ability to execute tasks in the Activities Classification level of the ICP model:[9][8][10]
- Berg Balance Scale (Level 2 = reasonable to recommend)
- Dynamic Gait Index
- Timed Up and Go
Measures that help determine participation in society:[1][8]
- The Activities-Specific Balance Scale (level 2)
- Dizziness Handicap Inventory (Level 4 = Highly recommended)
- Other measures for Quality of Life such as the Vestibular Disorder Activities of Daily Living
On the Body Structure and Function level, additional outcome measures that can be used:[8]
- Gait Stabilization Test
- Sharpened Romburg
- Sensory Organization Test with Head Shake, (Modified) Clinical Test of Sensory Interaction on Balance
- Visual Analogue Scale
- Visual Vertigo Analogue Scale
- Motion Sensitivity Quotient, and/or Vertigo Symptoms Scale
Additional outcome measures for Activity/Participation:[8]
- Five Times Sit-to-Stand
- 30-Second Chair Stand
- Functional Reach/Modified Functional Reach
- Gait Velocity (10m Walk Test)
- Balance Evaluations Systems Test
- Mini Balance Evaluation Systems Test
- Modified Timed Up and Go with Dual Task
- Disability Rating Scale
- UCLA Dizziness Questionnaire
- Vertigo Handicap Questionnaire
- Vestibular Handicap Questionnaire
- Vestibular Activities and Participation
- Vestibular Rehabilitation Benefit Questionnaire
Resources
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Additional information can be found on https://vestibular.org/BVH
Clinical Practice Guideline can be found on https://vestibular.org/sites/default/files/Cynthia/Vestibular%20Rehab%20CPG%20JNPT%202016.pdf
Outcome measure reviews can be found on http://www.neuropt.org/professional-resources/neurology-section-outcome-measures-recommendations/vestibular-disorders.
Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 Porciuncula F, Johnson CC, Glickman LB. The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review. Journal of Vestibular Research. 2012 Jan 1;22(5, 6):283-98.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Lucieer F, Vonk P, Guinand N, Stokroos R, Kingma H, van de Berg R. Bilateral vestibular hypofunction: insights in etiologies, clinical subtypes, and diagnostics. Frontiers in neurology. 2016;7.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 van de Berg R, van Tilburg M, Kingma H. Bilateral vestibular hypofunction: challenges in establishing the diagnosis in adults. ORL. 2015 Sep 15;77(4):197-218.
- ↑ 4.0 4.1 4.2 4.3 4.4 Herdman SJ. Bilateral Vestibular Hypofunction.
- ↑ 5.0 5.1 Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngology–Head & Neck Surgery. 2013 Aug 1;139(8):803-10.
- ↑ 6.0 6.1 Telian SA, Shepard NT, Smith-Wheelock M, Hoberg M. Bilateral vestibular paresis: diagnosis and treatment. Otolaryngology—Head and Neck Surgery. 1991 Jan;104(1):67-71.
- ↑ 7.0 7.1 Horak FB, Jones-Rycewicz C, Black FO, Shumway-Cook A. Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg. 1992;106(2):175-180.
- ↑ 8.0 8.1 8.2 8.3 8.4 Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, Furman JM, Getchius TS, Goebel JA, Shepard NT, Woodhouse SN. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American physical therapy association neurology section. Journal of Neurologic Physical Therapy. 2016 Apr;40(2):124.
- ↑ 9.0 9.1 Brown KE, Whitney SL, Wrisley DM, Furman JM. Physical therapy outcomes for persons with bilateral vestibular loss. The Laryngoscope. 2001 Oct 1;111(10):1812-7.
- ↑ Whitney S, Wrisley D, Furman J. Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiotherapy Research International. 2003 Nov 1;8(4):178-86.
