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Bilateral Vestibular Hypofunction (BVH)

Bilateral Vestibular Hypofunction (BVH) is a condition in which both vestibular systems in the inner ears are impaired, reducing the brain’s ability to process balance and spatial orientation signals. This leads to significant challenges with balance, especially in low-light conditions, and a sensation of unsteadiness. Understanding the symptoms, causes, diagnostic methods, and treatment options is essential for effective management.

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What is Bilateral Vestibular Hypofunction?

In BVH, both inner ear vestibular systems fail to function properly, leading to decreased or absent input to the brain about head and body movements. This condition disrupts the brain’s ability to maintain balance, particularly during activities that require precise coordination or in environments where visual cues are limited. The severity of BVH can range from mild dysfunction to complete loss of vestibular function.

Symptoms of BVH

The hallmark symptoms of BVH include:

  • Balance and Gait Issues:
    • Unsteadiness, especially when walking in the dark or on uneven surfaces.
    • Difficulty maintaining balance during quick movements or turns.
  • Visual Disturbances:
    • Oscillopsia (a sensation of the environment bouncing or moving, particularly during head movements).
  • Generalised Symptoms:
    • Dizziness or lightheadedness.
    • Increased risk of falls.

Unlike some other vestibular disorders, BVH does not typically cause vertigo or spinning sensations because both sides are equally impaired, eliminating the asymmetry that usually triggers vertigo.

How Common is BVH?

BVH is relatively rare, with a prevalence estimated at around 28 per 100,000 individuals. It can occur at any age but is more commonly seen in older adults due to age-related degeneration of the vestibular system.

Causes of BVH

BVH can result from various causes, including:

  • Ototoxicity: Damage to the inner ear caused by certain medications, such as aminoglycoside antibiotics.
  • Age-Related Degeneration: Natural wear and tear of the vestibular system with aging.
  • Autoimmune Inner Ear Disease: Immune-mediated damage to the vestibular organs.
  • Infections: Severe or recurrent infections affecting the inner ear.
  • Idiopathic: In some cases, the cause remains unknown.

Diagnosing BVH

Diagnosis involves a detailed clinical evaluation and specialised tests to assess vestibular function:

  1. Clinical History:
    • Detailed account of symptoms and their impact on daily life.
    • History of medication use, infections, or other potential risk factors.
  2. Vestibular Testing:
    • Video Head Impulse Test (vHIT): Measures the vestibulo-ocular reflex (VOR).
    • Rotational Chair Testing: Evaluates the function of both vestibular systems.
    • Vestibular Evoked Myogenic Potentials (VEMP): Assesses specific vestibular pathways.
  3. Audiological Tests:
    • Hearing tests may be performed to rule out coexisting inner ear disorders.
  4. Imaging Studies:
    • MRI may be used to exclude other neurological or structural causes.

Treatment Options & Outcomes

While the damage to the vestibular system is often permanent, treatments can significantly improve quality of life:

  1. Vestibular Rehabilitation Therapy (VRT):
    • Proven to improve functional mobility and reduce fall risk.
  2. Assistive Devices:
    • Use of canes or walking aids to improve stability during ambulation.
  3. Lifestyle Modifications:
    • Creating well-lit and clutter-free environments to reduce fall risk.
    • Avoiding activities that could provoke unsteadiness without proper support.
  4. Emerging Therapies:
    • Vestibular implants are an experimental technology that may offer future solutions for BVH patients.

With a dedicated management plan, individuals with BVH can improve their functional independence and reduce the impact of symptoms on daily life.

Bilateral Vestibular Hypofunction is a challenging condition that affects balance and stability. Early diagnosis and targeted vestibular rehabilitation can significantly improve quality of life and reduce fall risk. If you experience persistent unsteadiness or oscillopsia, consult a healthcare professional for an accurate diagnosis and tailored care plan.

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