Bilateral Vestibular Hypofunction

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Definition/Description
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Epidemiology 
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BVH is an uncommon condition that is frequently misdiagnosed or underdiagnosed.[1] 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. <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="van de Berg" />[2][3] Individuals diagnosed with BVH are more likely to present with social, physical and functional impairments and limitations.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Ward" /> 

Etiology/Cause [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.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Lucieer" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="van de Berg" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Herdman" /> 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).<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Lucieer" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="van de Berg" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Herdman" /> Other known causes may be the result of an infection (3.8-12%) such as meningitis, and encephalitis.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Lucieer" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="van de Berg" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Herdman" />

Clinical Presentation[edit | edit source]

add text here relating to diagnostic tests for the condition

Diagnostic Procedure [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 (Lucieer, Telian, van de berg). However, symptoms specific to, and commonly reported by patients include ; oscillopsia (strong indicator of BVH), unsteadiness, episodic and spontaneous vertigo (Telian).

Vestibular tests performed to help diagnose BVH include:<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="van de Berg" /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Lucieer" />

  • 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 include:<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Lucieer" />

  • Cerebral imaging
  • Audiometry
  • Blood Tests

Outcome Measures
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Outcome measures are based on the International Classification of Function Model. [4][5] Common outcome measures influencing the Body Structure and Function level in the ICF model include Cite error: The opening <ref> tag is malformed or has a bad name [6]
*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 include: Cite error: The opening <ref> tag is malformed or has a bad nameCite error: The opening <ref> tag is malformed or has a bad name[7]
*Berg Balance Scale (Level 2 = reasonable to recommend) *Dynamic Gait Index *Timed Up and Go Measures that help determine participation in society include: Cite error: The opening <ref> tag is malformed or has a bad nameCite error: The opening <ref> tag is malformed or has a bad name *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 include:Cite error: The opening <ref> tag is malformed or has a bad name *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 include: Cite error: The opening <ref> tag is malformed or has a bad name
*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 .

Physiotherapy Management/Intervention 
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Resources
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Case Studies[edit | edit source]

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Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)[edit | edit source]

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References[edit | edit source]

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  1. ↑ 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.
  2. ↑ 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 &amp;amp;amp; Neck Surgery. 2013 Aug 1;139(8):803-10.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  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.
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