Bilateral Vestibular Hypofunction

  • Zachary G. Schwam
  • Seilesh Babu
  • Christopher A. Schutt


Bilateral vestibular hypofunction is a devastating disease characterized by oscillopsia and a loss of the vestibulo-ocular reflex. Diagnosis is made by performing specialized bedside exams as well as rotary chair, calorics, and videonystagmography. To date, treatment has been vestibular rehabilitation therapy with mixed results. A vestibular implant is currently in trials to address this problem.


Bilateral vestibular hypofunction Vestibulopathy Vestibulo-ocular reflex Vestibular prosthesis Vestibular rehabilitation therapy Gentamicin ototoxicity Vestibular implant Multichannel vestibular prosthesis 


  1. 1.
    Dandy WE. The surgical treatment of Meniere’s disease. Surg Gynecol Obstet. 1941;72:421–5.Google Scholar
  2. 2.
    Brown KE, Whitney SL, Wrisley DM, Furman JM. Physical therapy outcomes for persons with bilateral vestibular loss. Laryngoscope. 2001;111:1812–7.CrossRefGoogle Scholar
  3. 3.
    McGath JH, Barber HO, Stoyanoff S. Bilateral vestibular loss and oscillopsia. J Otolaryngol. 1989;18:218–21.PubMedGoogle Scholar
  4. 4.
    Vibert D, Liard P, Hausler R. Bilateral idiopathic loss of peripheral vestibular function with normal hearing. Acta Otolaryngol. 1995;115:611–5.CrossRefGoogle Scholar
  5. 5.
    Rinne T, Bronstein AM, Rudge P, Gresty MA, Luxon LM. Bilateral loss of vestibular function: clinical findings in 53 patients. J Neurol. 1998;245:314–21.CrossRefGoogle Scholar
  6. 6.
    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 Otolaryngol Head Neck Surg. 2013;139:803–10.CrossRefGoogle Scholar
  7. 7.
    Minor LB. Gentamicin-induced bilateral vestibular hypofunction. JAMA. 1998;279:541–4.CrossRefGoogle Scholar
  8. 8.
    Dulon D, Hiel HA, Aurousseau C, Erre JP, Aran JM. Pharmacokinetics of gentamicin in the sensory hair cells of the organ of Corti: rapid uptake and long term persistence. C R Acad Sci III. 1993;316:682–7.PubMedGoogle Scholar
  9. 9.
    Matz GJ. Aminoglycoside cochlear ototoxicity. Otolaryngol Clin N Am. 1993;26:705–12.Google Scholar
  10. 10.
    Priuska EM, Schacht J. Formation of free radicals by gentamicin and iron and evidence for an iron/gentamicin complex. Biochem Pharmacol. 1995;50:1749–52.CrossRefGoogle Scholar
  11. 11.
    Garetz SL, Altschuler RA, Schacht J. Attenuation of gentamicin ototoxicity by glutathione in the guinea pig in vivo. Hearing Res. 1994;77:81–7.CrossRefGoogle Scholar
  12. 12.
    Song B, Schacht J. Protective effects of iron chelators on gentamicin ototoxicity. Inner Ear Biol Abst. 1995;32:0–8.Google Scholar
  13. 13.
    Conlon BJ, Smith DW. Supplemental iron exacerbated aminoglycoside ototoxicity. Hear Res. 1998;115:1–5.CrossRefGoogle Scholar
  14. 14.
    Ylikoski J, Xing-Qun J, Virkkala U, Pirvola U. Blockage of c-jun N-terminal kinase pathway attenuates gentamicin-induced cochlear and vestibular hair cell death. Hear Res. 2002;166:33–43.CrossRefGoogle Scholar
  15. 15.
    De Jager P, van Altena R. Hearing loss and nephrotoxicity in long-term aminoglycoside treatment in patients with tuberculosis. Int J Tuberc Lung Dis. 2002;6:622–7.PubMedGoogle Scholar
  16. 16.
    Smith C, Lipsky JJ, Lietman PS. Relationship between aminoglycoside-induced nephrotoxicity and auditory toxicity. Antimicrob Agents Chemother. 1979;15:780–2.CrossRefGoogle Scholar
  17. 17.
    Hain TC, Cherchi M, Yacovino DA. Bilateral vestibular loss. Semin Neurol. 2013;33:195–203.CrossRefGoogle Scholar
  18. 18.
    Telian SA, Shephard NT, Smith-Wheelock M, Hoberg M. Bilateral vestibular paresis: diagnosis and treatment. Otolaryngol Head Neck Surg. 1991;104:67–71.CrossRefGoogle Scholar
  19. 19.
    Demer JL, Honrubia V, Baloh RW. Dynamic visual acuity: a test for oscillopsia and vestibulo-ocular reflex function. Am J Otol. 1994;15:340–7.PubMedGoogle Scholar
  20. 20.
    Gillespie MB, Minor LB. Prognosis in bilateral vestibular hypofunction. Laryngoscope. 1999;109:35–41.CrossRefGoogle Scholar
  21. 21.
    Longridge NS, Mallinson AI. A discussion of the dynamic illegible “E” test: a new method of screening for aminoglycoside vestibulotoxicity. Otolaryngol Head Neck Surg. 1984;92:671–7.CrossRefGoogle Scholar
  22. 22.
    Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology. 2009;72:1417–24.CrossRefGoogle Scholar
  23. 23.
    Schubert MC, Minor LB. Vestibulo-ocular physiology underlying vestibular hypofunction. Phys Ther. 2004;84:373–85.PubMedGoogle Scholar
  24. 24.
    Fife TF, Tusa RJ, Furman JM, et al. Assessment: vestibular testing techniques in adults and children: report of the Therapeutic Technology Assessment subcommittee of the American Academy of Neurology. Neurology. 2000;55:1431–41.CrossRefGoogle Scholar
  25. 25.
    Zapala DA, Olsholt KF, Lundy LB. A comparison of water and air caloric responses and their ability to distinguish between patients with normal and impaired ears. Ear Hear. 2008;29:585–600.CrossRefGoogle Scholar
  26. 26.
    Krebs DE, Gill-Body KM, Riley PO, Parker SW. Double-blind, placebo controlled trial of rehabilitation for bilateral vestibular hypofunction: a preliminary report. Otolaryngol Head Neck Surg. 1993;109:735–41.CrossRefGoogle Scholar
  27. 27.
    Herdman SJ, Hall CD, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in bilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg. 2007;133:383–9.CrossRefGoogle Scholar
  28. 28.
    Della Santina CC, Migliaccio AA, Hayden R, et al. Current and future management of bilateral loss of vestibular sensation-an update on the Johns Hopkins multichannel vestibular prosthesis project. Cochlear Implants Int. 2010;11:2–11.CrossRefGoogle Scholar
  29. 29.
    Della Santina C, Migliaccio A, Patel A. Electrical stimulation to restore vestibular function development of a 3-d vestibular prosthesis. Conf Proc IEEE Eng Med Biol Soc. 2005;7:7380–5.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Chiang B, Fridman GY, Dai C, Rahman MA, Della Santina CC. Design and performance of a multichannel vestibular prosthesis that restores semicircular canal sensation in rhesus monkey. IEEE Trans Neural Syst Rehabil Eng. 2011;19:588–98.CrossRefGoogle Scholar
  31. 31.
    Dai C, Fridman GY, Davidovics NS, Chiang B, Ahn JH, Della Santina CC. Restoration of 3D vestibular sensation in rhesus monkeys using a multichannel vestibular prosthesis. Hear Res. 2011;281:74–83.CrossRefGoogle Scholar
  32. 32.
    Dai C, Fridman GY, Della Santina CC. Effects of vestibular prosthesis electrode implantation and stimulation on hearing in rhesus monkeys. Hear Res. 2011;277:204–10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Zachary G. Schwam
    • 1
  • Seilesh Babu
    • 2
  • Christopher A. Schutt
    • 2
  1. 1.Department of OtolaryngologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Neurotology, Providence HospitalMichigan Ear InstituteFarmington HillsUSA

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