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  • Bilateral vestibulopathy

  • Bilateral vestibular (BVL)


  • 386.54 Hypoactive labyrinth, bilateral


  • H81.23 Vestibular neuronitis, bilateral


  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling1

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2


While working as a relief aide in an underdeveloped country, a 50-year-old woman became extremely ill from a bacterial infection. She was treated with several antibiotics during her hospital stay. Since her discharge from the hospital she has noted several episodes of dizziness throughout the day. Often the feeling of movement doesn’t stop when she sits down. She reports losing her balance frequently but more often at night or very early in the morning when she gets out of bed. She displays symptoms of dizziness during vestibulo-ocular reflex (VOR) testing, but no hearing changes or diplopia. CT scan of the head was normal.



  • Disorder of the peripheral vestibular system (part of the inner ear).

  • The peripheral vestibular system of each ear is made up of the vestibular nerve and five sensory organs (hair cell receptors contained within the superior, posterior, and horizontal semicircular canals, and also within the utricle and saccule).

  • Vestibular sensory organs detect head position and head motion to provide input for gaze stability, orientation, and balance.

  • Reduction or loss of vestibular function of both systems causes a reduction or loss of neural input, resulting in gaze instability, disorientation, and imbalance.

Essentials of Diagnosis

  • Physical examination normal

  • Audiogram normal

  • Neurotologic examination abnormal

  • Thorough, detailed history essential to distinguish bilateral vestibulopathy from other vestibular disorders or central pathology

General Considerations

  • Hallmark symptom is gaze instability and imbalance.

  • Impairments tend to develop slowly and progressively in most cases, and tend to be more severe than those with unilateral dysfunction.

  • Patient complaints may be overlooked as being due to inner ear pathology because reports of vertigo are rare.

  • There must be pathological asymmetry of the neural activity between the two inner ears for symptoms of vertigo to occur; with bilateral vestibulopathy, neural impairment or loss is often equal between the two ears and will not create vertigo.

  • Patients may or may not report dizziness from head movement

  • Patients do not typically report hearing loss, aural fullness, or tinnitus.


  • Bilateral vestibulopathy is rare among vestibular disorders

  • May account for 4% to 9% of diagnoses in clinics specialized in vestibular disorders

  • Primarily occurs between ages 61 and 70 years, though can occur at any age



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