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Bilateral Vestibular Failure: Causes and Courses 

Bilateral Vestibular Failure: Causes and Courses
Bilateral Vestibular Failure: Causes and Courses

Thomas Brandt

, Marianne Dieterich

, and Michael Strupp

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date: 30 July 2021

Bilateral vestibular failure (BVF) due to bilateral disorders of the labyrinth or the eighth nerves accounts for about 6% of outpatients in a neurological dizziness unit. BVF has various etiologies: the most frequent are ototoxic antibiotics, Menière’s disease, meningitis, and neurodegenerative disorders. Its etiology remains unclear in approximately half of the patients. The diagnosis is often not established despite the presence of the typical key symptoms of oscillopsia and blurred vision during head movements (defective vestibulo-ocular reflex) and unsteadiness of stance and gait in the dark (defective vestibulo-spinal postural control). The diagnostic proof is based on a pathological head-impulse test and severe hypo- or unresponsiveness to bithermal caloric irrigation. Treatment is limited and follows three lines of action: prophylaxis of progressive vestibular loss, recovery of vestibular function, and most important, physical therapy that promotes compensation and substitution of missing vestibular input by visual and somatosensory cues. Long-term follow-up reveals that the spontaneous course is unfavorable: there is only limited improvement, particularly in patients with idiopathic BVF or with meningitis.

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