Summary
Bilateral Vestibular Hypofunction or Loss (BVH or BVL) makes it hard for people to keep their balance, especially when walking in the dark or on uneven ground. It can also cause problems with seeing clearly when they move their heads. This means they might be more likely to fall, feel dizzy, or have balance problems, which can affect their overall health. While there are different ways to treat this condition, many patients may still have symptoms even after treatment.
Background
When someone loses balance control in both inner ears (a condition called bilateral vestibular hypofunction), they find it hard to walk steadily, especially in the dark or on uneven ground. This can make them feel really off-balance and cause weird sensations in their heads when they move. As a result, people might avoid activities and feel isolated. Another concern is oscillopsia, a condition characterized by blurred vision when moving the head. About 70% of people with bilateral vestibular hypofunction experience this, even after treatment. Some may find that their eyesight weakens when they move their heads, making it hard to read signs or recognize faces while walking.
Bilateral vestibular hypofunction can happen for several reasons, such as taking certain medications, infections, or other health conditions. Sometimes, there’s no clear cause, which is often called “idiopathic.” People with this condition mainly worry about balancing and falling. For example, someone who has taken a medication that affects balance might not realize they have a problem until they try to get out of bed. Others with a gradual loss might only notice their balance issues when they start falling.
Diagnostic Criteria for Bilateral Vestibulopathy
In 2017, a group of experts called the Bárány Society created a set of rules to diagnose bilateral vestibulopathy, which affects balance:
- Patients must have a long-term problem with balance, which includes:
- Feeling unsteady when walking or standing, plus:
- Blurry vision or dizziness when moving quickly or in low light.
- No issues when sitting or lying down.
- Tests must show reduced balance reflexes, checked by:
- Video head impulse tests or other techniques.
- Caloric tests.
- Rotational chair tests.
- No other disease should explain the symptoms.
Assessment
When evaluating patients with bilateral vestibulopathy (BVL), physical therapy should focus on balance, daily activities, overall physical condition, and any visual or sensory problems. Doctors will check if there is any remaining balance function, which helps predict recovery. Patients with less severe loss may return to nighttime driving and sports, while those with severe loss might struggle with these activities.
Treatment
For people who have lost their balance and inner ear function, doctors suggest doing specific exercises. These include moves that help stabilize their eyes and balance, which can be especially helpful when they really need to maintain their balance. The same exercises can also help those with partial balance problems. Patients can also learn ways to cope. For example, turning on lights at night or waiting to get up until their eyes adjust to the darkness. Some might need devices like shopping carts or canes in busy places, but many can manage without them once they get used to walking around.
Future Treatment
Researchers are exploring new tools to help replace lost balance function, such as devices that provide auditory or tactile cues. While these can help with posture, they don’t yet improve how well a person sees while moving their head. Some scientists are working on a special implant that could stimulate nerves in the inner ear and help restore balance. Early animal studies showed promise, with some improvement in balance and eye movements. In a Johns Hopkins study, eight patients with balance problems showed improvement after receiving a balance implant. They noticed better posture and walking, but most had some hearing loss in the implanted ear.
Summary
People with balance issues can often return to many activities, but they might still struggle with certain tasks. They may be able to walk without aids in well-lit areas and go back to work, but it might require finding a different job. Some find driving difficult in bad weather, but their overall driving safety is similar to that of people with normal balance. Treatment focuses on improving their existing balance system, using other strategies to help with balance and stability, and making their homes and workplaces safer.
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